Provider Demographics
NPI:1467643163
Name:HOSS-GREEN, DONNA J (FNP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:HOSS-GREEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:J
Other - Last Name:BLESSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1426 CANYON AVE NE STE C
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-4832
Mailing Address - Country:US
Mailing Address - Phone:386-208-0537
Mailing Address - Fax:386-208-0571
Practice Address - Street 1:1426 CANYON AVE NE STE C
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-4832
Practice Address - Country:US
Practice Address - Phone:386-208-0537
Practice Address - Fax:386-208-0571
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024181484363LF0000X
IL209-006696363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid
ILF400283290Medicare PIN