MEDICARE: LAURA GRACE DONOVAN ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	ARNP9169004	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013924422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA GRACE DONOVAN ARNP

Provider Business Mailing Address
First Line	:	3010 W AZEELE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3139
Country	:	US
Telephone Number	:	813-877-2200
Fax Number	:	813-872-7037

Provider Business Practice Location Address
First Line	:	3010 W AZEELE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3139
Country	:	US
Telephone Number	:	813-877-2200
Fax Number	:	813-872-7037

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	08/28/2014

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