Healthcare Provider Details

I. General information

NPI: 1063980647
Provider Name (Legal Business Name): BRIDGETT V DONALSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21298 OLEAN BLVD
PORT CHARLOTTE FL
33952-6705
US

IV. Provider business mailing address

21298 OLEAN BLVD
PORT CHARLOTTE FL
33952-6705
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-6860
  • Fax: 239-343-6162
Mailing address:
  • Phone: 239-343-6860
  • Fax: 239-343-6162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11001205
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9293389
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: