Provider Demographics
NPI:1629496385
Name:DONNER, ANGELA IRENE (ARNP)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:IRENE
Last Name:DONNER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2553 MASON OAKS DR
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-6498
Mailing Address - Country:US
Mailing Address - Phone:813-940-6046
Mailing Address - Fax:866-451-4607
Practice Address - Street 1:2553 MASON OAKS DR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596-6498
Practice Address - Country:US
Practice Address - Phone:813-940-6046
Practice Address - Fax:866-451-4607
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2524302363L00000X, 363LG0600X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015734400Medicaid