Provider Demographics
NPI:1457783185
Name:FECHTMULLER, DONNA MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:FECHTMULLER
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 1:14075 OCEAN PINE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7439
Mailing Address - Country:US
Mailing Address - Phone:904-305-2070
Mailing Address - Fax:407-858-5523
Practice Address - Street 1:434 GROVE AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789
Practice Address - Country:US
Practice Address - Phone:407-644-5567
Practice Address - Fax:407-858-5999
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9185263367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009602200Medicaid
FL009602200Medicaid