Provider Demographics
NPI:1538954268
Name:MACDONALD, BIANCA ELIZABETH
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:ELIZABETH
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:ELIZABETH
Other - Last Name:LAFONTAINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2311 7TH ST SW
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-5562
Mailing Address - Country:US
Mailing Address - Phone:727-479-9109
Mailing Address - Fax:
Practice Address - Street 1:2311 7TH ST SW
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-5562
Practice Address - Country:US
Practice Address - Phone:727-479-9109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-12
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9516786163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse