Provider Demographics
NPI:1952525487
Name:TEAGUE, DONNA (CFM)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8041 DEERWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-9583
Mailing Address - Country:US
Mailing Address - Phone:813-802-4075
Mailing Address - Fax:
Practice Address - Street 1:8041 DEERWOOD CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-9583
Practice Address - Country:US
Practice Address - Phone:813-802-4075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4936930001Medicare PIN