Provider Demographics
NPI:1104959139
Name:GOOD, DONNA A (DOM, AP)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:A
Last Name:GOOD
Suffix:
Gender:F
Credentials:DOM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E WILBUR AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3225
Mailing Address - Country:US
Mailing Address - Phone:407-321-0750
Mailing Address - Fax:
Practice Address - Street 1:141 E WILBUR AVE
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3225
Practice Address - Country:US
Practice Address - Phone:407-321-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1349171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist