MEDICARE: MRS. DONNA JEANNETTE COTHREN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ARNP9167134	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255703302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNA JEANNETTE COTHREN

Provider Business Mailing Address
First Line	:	6387 CHURCH AVE
Second Line	:
City	:	BRYCEVILLE
State	:	FL
Zip	:	32009-1838
Country	:	US
Telephone Number	:	904-424-7804
Fax Number	:

Provider Business Practice Location Address
First Line	:	4319 SALISBURY RD STE 103
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-0941
Country	:	US
Telephone Number	:	904-570-9404
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2015
Last Update Date	:	11/23/2020

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Directions to “ MRS. DONNA JEANNETTE COTHREN ” Practice Location

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