Provider Demographics
NPI:1215169123
Name:DONNELLY, ANNE BERNADETTE (APRN)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:BERNADETTE
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 SW 5TH WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-4731
Mailing Address - Country:US
Mailing Address - Phone:561-213-0763
Mailing Address - Fax:
Practice Address - Street 1:2900 N MILITARY TRL STE 245
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6362
Practice Address - Country:US
Practice Address - Phone:561-994-2007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1558792363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily