Provider Demographics
NPI:1972585602
Name:FONTENOT, DONALD JOSEPH JR (CRNA)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:JOSEPH
Last Name:FONTENOT
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 US 98 NAVAL HOSPITAL PENSACOLA
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32512-0001
Mailing Address - Country:US
Mailing Address - Phone:850-505-6761
Mailing Address - Fax:
Practice Address - Street 1:6000 US 98
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32512-2341
Practice Address - Country:US
Practice Address - Phone:850-505-6761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9210209367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013907200Medicaid
FLG3531OtherBCBS
FLG3531OtherBSFL