Provider Demographics
NPI:1801970843
Name:MACDONALD, JOSEPHINE M (CRNA)
Entity type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:M
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:3063 RIO PINO N
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-3732
Mailing Address - Country:US
Mailing Address - Phone:321-777-5769
Mailing Address - Fax:321-777-1557
Practice Address - Street 1:315 E NASA BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1939
Practice Address - Country:US
Practice Address - Phone:321-723-7716
Practice Address - Fax:321-726-0641
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYARNP1853972367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered