MEDICARE: CARA ELIZABETH DONNELLY DO

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	390200000X	Student in an Organized Health Care Education/Training Program	TL.0008874	CO
2	207Q00000X	Family Medicine Physician	DR.0071497	CO
3	207Q00000X	Family Medicine Physician	OS23274	FL
4	207Q00000X	Family Medicine Physician	O-2008	ID

General Provider Information

NPI Number	:	1942874748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARA ELIZABETH DONNELLY DO

Provider Business Mailing Address
First Line	:	1881 SE TIFFANY AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7567
Country	:	US
Telephone Number	:	772-398-7936
Fax Number	:

Provider Business Practice Location Address
First Line	:	1881 SE TIFFANY AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7567
Country	:	US
Telephone Number	:	772-398-7936
Fax Number	:

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

Provider Enumeration Date	:	05/17/2021
Last Update Date	:	04/02/2026

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