Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 43401 | FL |
N | 207RG0300X | Geriatric Medicine | 4484 | AL |
NPI | 1154612380 |
---|---|
Provider Name | Dr. Donna Jacobi Pruett |
First Address | Pensacola, FL 32514-4937 |
Second Address | Pensacola, FL 32514-2724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2011 |
Last Update Date | 21/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009914935 | (05) | AL |
067241600 | (05) | FL |
BJ0375673 | DEA (01) | FL |
D53366 | (02) | FL |