Provider Demographics
NPI:1336937275
Name:MCDANIEL, DONNA WILGUS (RDN)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:WILGUS
Last Name:MCDANIEL
Suffix:
Gender:
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 BETA CT
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5103
Mailing Address - Country:US
Mailing Address - Phone:407-388-4083
Mailing Address - Fax:
Practice Address - Street 1:2121 BETA CT
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5103
Practice Address - Country:US
Practice Address - Phone:407-388-4083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4650133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered