Healthcare Provider Details

I. General information

NPI: 1114092889
Provider Name (Legal Business Name): DONNA H. WYNN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3229 BEAR RUN BLVD BLDG B
ORANGE PARK FL
32065-7334
US

IV. Provider business mailing address

PO BOX 578
GREEN COVE SPRINGS FL
32043-0578
US

V. Phone/Fax

Practice location:
  • Phone: 904-269-6340
  • Fax: 904-284-6373
Mailing address:
  • Phone: 904-269-6340
  • Fax: 904-284-6373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP498812
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP498812
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: