Provider Demographics
NPI:1528886637
Name:CHANG, DONNA M (RN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:CHANG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NA
Other - Middle Name:NA
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1171 BEACH BLVD STE 105A
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3419
Mailing Address - Country:US
Mailing Address - Phone:904-476-3305
Mailing Address - Fax:904-476-3305
Practice Address - Street 1:1171 BEACH BLVD STE 105A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3419
Practice Address - Country:US
Practice Address - Phone:904-476-3305
Practice Address - Fax:904-476-3305
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2939692163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine