Healthcare Provider Details

I. General information

NPI: 1215169123
Provider Name (Legal Business Name): ANNE BERNADETTE DONNELLY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 N MILITARY TRL STE 245
BOCA RATON FL
33431-6362
US

IV. Provider business mailing address

42 SW 5TH WAY
BOCA RATON FL
33432-4731
US

V. Phone/Fax

Practice location:
  • Phone: 561-994-2007
  • Fax:
Mailing address:
  • Phone: 561-213-0763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN1558792
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: