Healthcare Provider Details

I. General information

NPI: 1538954268
Provider Name (Legal Business Name): BIANCA ELIZABETH MACDONALD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BIANCA ELIZABETH LAFONTAINE

II. Dates (important events)

Enumeration Date: 04/12/2025
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E WASHINGTON ST
PARIS TN
38242-4017
US

IV. Provider business mailing address

2333 SHADY GROVE RD
MC KENZIE TN
38201-7631
US

V. Phone/Fax

Practice location:
  • Phone: 727-479-9109
  • Fax:
Mailing address:
  • Phone: 727-479-9109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11050955
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: