Provider Demographics
NPI:1386603942
Name:DONAHUE, CLARICE ELLEN (ARNP)
Entity type:Individual
Prefix:
First Name:CLARICE
Middle Name:ELLEN
Last Name:DONAHUE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 HIGHWAY A1A
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-2510
Mailing Address - Country:US
Mailing Address - Phone:772-532-9124
Mailing Address - Fax:772-234-6759
Practice Address - Street 1:695 HIGHWAY A1A
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-2510
Practice Address - Country:US
Practice Address - Phone:772-532-9124
Practice Address - Fax:772-234-6759
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3198122363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305929400Medicaid
FLS75015Medicare UPIN
FL305929400Medicaid