Provider Demographics
NPI:1780711424
Name:DONALDSON, SUSAN A (MSN, ARNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:MSN, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24714 NW 157TH ST
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-3013
Mailing Address - Country:US
Mailing Address - Phone:352-262-1256
Mailing Address - Fax:
Practice Address - Street 1:24714 NW 157TH ST
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-3013
Practice Address - Country:US
Practice Address - Phone:352-262-1256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9221220363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307825600Medicaid