Healthcare Provider Details

I. General information

NPI: 1447219597
Provider Name (Legal Business Name): DONNA J LYNESS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2006
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 SW 33RD RD
OCALA FL
34474
US

IV. Provider business mailing address

19548 SW 86TH LN
DUNNELLON FL
34432-2671
US

V. Phone/Fax

Practice location:
  • Phone: 352-873-9311
  • Fax: 352-873-9652
Mailing address:
  • Phone: 304-777-9047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number33222
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: