Healthcare Provider Details

I. General information

NPI: 1215997614
Provider Name (Legal Business Name): DONNA J BOMAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 BAY PINES BLVD
BAY PINES FL
33744
US

IV. Provider business mailing address

12140 92ND AVE
SEMINOLE FL
33772-2652
US

V. Phone/Fax

Practice location:
  • Phone: 727-398-6661
  • Fax: 727-319-1231
Mailing address:
  • Phone: 727-686-3472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP2496662
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: