Provider Demographics
NPI:1366511875
Name:DONOVAN, JENNIFER SARA (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SARA
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 STRATHY LN
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4133
Mailing Address - Country:US
Mailing Address - Phone:407-328-3073
Mailing Address - Fax:407-628-3078
Practice Address - Street 1:218 STRATHY LN
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4133
Practice Address - Country:US
Practice Address - Phone:407-628-3073
Practice Address - Fax:407-628-3078
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102088363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P81479Medicare UPIN