Provider Demographics
NPI:1972360188
Name:ROUSSEAU, DONKENSON L (APRN)
Entity type:Individual
Prefix:
First Name:DONKENSON
Middle Name:L
Last Name:ROUSSEAU
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 CIVIC CENTER PL
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7803
Mailing Address - Country:US
Mailing Address - Phone:954-665-0843
Mailing Address - Fax:
Practice Address - Street 1:4801 WELDON SPRING PKWY
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-9101
Practice Address - Country:US
Practice Address - Phone:636-723-9306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11031626363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health