Healthcare Provider Details

I. General information

NPI: 1124488259
Provider Name (Legal Business Name): GINA DITTA-DONAHUE CNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 ROGERS BRIDGE RD STE 206A
DULUTH GA
30097-2803
US

IV. Provider business mailing address

7362 UNIVERSITY AVE NE STE 306
FRIDLEY MN
55432-3150
US

V. Phone/Fax

Practice location:
  • Phone: 470-266-1380
  • Fax: 866-528-3295
Mailing address:
  • Phone: 470-266-1380
  • Fax: 866-528-3295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12256
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN285530
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: