Provider Demographics
NPI:1699246405
Name:DONOHUE, JEAN MARIE (RN)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:DONOHUE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:MARIE
Other - Last Name:MAYNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4620 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-6205
Mailing Address - Country:US
Mailing Address - Phone:813-284-4529
Mailing Address - Fax:
Practice Address - Street 1:4620 N 22ND ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-6205
Practice Address - Country:US
Practice Address - Phone:813-284-4529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1977492163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management