Provider Demographics
NPI:1861429839
Name:CALDWELL, DONNA J (ARNP)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:J
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:JOANN LARSON
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:217 NE FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-2981
Practice Address - Country:US
Practice Address - Phone:386-758-1068
Practice Address - Fax:386-758-2180
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1362412363LX0001X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL033366200Medicaid