Basic Information
| Provider Information | |||||||||
| NPI: | 1003063538 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DISANTI | ||||||||
| FirstName: | DONNA | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3001 EXECUTIVE DR STE 130 | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337625323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273470005 | ||||||||
| FaxNumber: | 7275416558 | ||||||||
| Practice Location | |||||||||
| Address1: | 508 N ALEXANDER ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | PLANT CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335633036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137596607 | ||||||||
| FaxNumber: | 8137598997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2008 | ||||||||
| LastUpdateDate: | 08/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN2940562 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | ARNP2940562 | 01 | FL | STATE LIC. | OTHER |