Healthcare Provider Details

I. General information

NPI: 1992282115
Provider Name (Legal Business Name): DONNA L CALLAHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3590 CANOPY CIR
NAPLES FL
34120-0680
US

IV. Provider business mailing address

3590 CANOPY CIR
NAPLES FL
34120-0680
US

V. Phone/Fax

Practice location:
  • Phone: 413-530-3178
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9415485
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number9415485
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN215552
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number9415485
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: