Provider Demographics
NPI:1902331473
Name:DONOVAN, BRITT CHRISTINE AHLBERG
Entity Type:Individual
Prefix:MRS
First Name:BRITT
Middle Name:CHRISTINE AHLBERG
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:BRITT
Other - Middle Name:CHRISTINE
Other - Last Name:AHLBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1629 RUSTY RAIL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-5527
Mailing Address - Country:US
Mailing Address - Phone:904-476-5613
Mailing Address - Fax:
Practice Address - Street 1:800 PRUDENTIAL DR
Practice Address - Street 2:SUITE 204
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8202
Practice Address - Country:US
Practice Address - Phone:904-476-5613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101065363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant