Provider Demographics
NPI:1528288230
Name:JOHNSTON, DONNA M (DOM)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 W YORK CT
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4636
Mailing Address - Country:US
Mailing Address - Phone:407-682-7111
Mailing Address - Fax:
Practice Address - Street 1:683 DOUGLAS AVE
Practice Address - Street 2:STE 101
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2555
Practice Address - Country:US
Practice Address - Phone:407-682-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1996171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist