Healthcare Provider Details

I. General information

NPI: 1629246558
Provider Name (Legal Business Name): DONNA MARIE DICKSON ARNP-C MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1628 CROSSVINE CT
TRINITY FL
34655-4903
US

IV. Provider business mailing address

1628 CROSSVINE CT
TRINITY FL
34655-4903
US

V. Phone/Fax

Practice location:
  • Phone: 727-688-4400
  • Fax: 813-745-8327
Mailing address:
  • Phone: 727-688-4400
  • Fax: 813-745-8327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2915462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: