Basic Information
| Provider Information | |||||||||
| NPI: | 1639707516 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DONDINA | ||||||||
| FirstName: | SEVERINE | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1636 SHADOWOOD LN STE 106 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322072187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046950249 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1636 SHADOWOOD LN STE 106 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322072187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046950249 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2020 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 163W00000X | RN9495560 | FL | N | Nursing Service Providers | Registered Nurse | 363LP0808X | APRN11015622 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.