Provider Demographics
NPI:1962092296
Name:GORDON-DONELY, TUNISA
Entity type:Individual
Prefix:
First Name:TUNISA
Middle Name:
Last Name:GORDON-DONELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3859 SW 100TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-4191
Mailing Address - Country:US
Mailing Address - Phone:352-512-7527
Mailing Address - Fax:
Practice Address - Street 1:3859 SW 100TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-4191
Practice Address - Country:US
Practice Address - Phone:352-512-7527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261QD1600XMedicaid