Healthcare Provider Details

I. General information

NPI: 1619295482
Provider Name (Legal Business Name): DONNA BORRESEN AP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 N WICKHAM RD
MELBOURNE FL
32940-2028
US

IV. Provider business mailing address

1700 HARBOR OAKS PL
MERRITT ISLAND FL
32952-2901
US

V. Phone/Fax

Practice location:
  • Phone: 321-757-6899
  • Fax: 321-757-6859
Mailing address:
  • Phone: 321-506-2320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP1333
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: