Provider Demographics
NPI:1699301184
Name:MCDONALD, KERRY DAWN (FNP-BC)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:DAWN
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:NA
Other - Middle Name:NA
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:2915 BIRCHCREEK DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-7371
Mailing Address - Country:US
Mailing Address - Phone:813-476-1404
Mailing Address - Fax:
Practice Address - Street 1:3615 W HAMILTON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614
Practice Address - Country:US
Practice Address - Phone:813-977-0281
Practice Address - Fax:813-977-0536
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006626363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty