Healthcare Provider Details

I. General information

NPI: 1831298306
Provider Name (Legal Business Name): DONNA A STOUT RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 SW ARCHER ROAD
GAINESVILLE FL
32608-1197
US

IV. Provider business mailing address

PO BOX 501 25340 SW 17 TH AVENUE
NEWBERRY FL
32669-0501
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-1611
  • Fax:
Mailing address:
  • Phone: 352-472-5680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT2447
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: