Healthcare Provider Details

I. General information

NPI: 1255703302
Provider Name (Legal Business Name): MRS. DONNA JEANNETTE COTHREN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DONNA JEANNETTE WATSON ARNP

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4319 SALISBURY RD STE 103
JACKSONVILLE FL
32216-0941
US

IV. Provider business mailing address

6387 CHURCH AVE
BRYCEVILLE FL
32009-1838
US

V. Phone/Fax

Practice location:
  • Phone: 904-570-9404
  • Fax:
Mailing address:
  • Phone: 904-424-7804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9167134
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: