Healthcare Provider Details

I. General information

NPI: 1912898388
Provider Name (Legal Business Name): JANE DONAHOO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7749 NORMANDY BLVD STE 147
JACKSONVILLE FL
32221-7658
US

IV. Provider business mailing address

3901 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-4312
US

V. Phone/Fax

Practice location:
  • Phone: 904-786-5576
  • Fax:
Mailing address:
  • Phone: 904-345-7251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ12733
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: