Provider Demographics
NPI:1346077112
Name:DONOVAN, ELIZABETH JOAN (RN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JOAN
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:RN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 W MAIN ST APT F
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3929
Mailing Address - Country:US
Mailing Address - Phone:845-326-2196
Mailing Address - Fax:
Practice Address - Street 1:200 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2479
Practice Address - Country:US
Practice Address - Phone:860-676-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13380363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily