Individual provider Active NPI

Donna Marie Dickson, ARNP-C MSN

  • Adult Health Nurse Practitioner
  • Trinity, FL
National Provider Identifier
1629246558
Registry record updated Jun 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
2915462 Issued in FL
Practice address
1628 Crossvine CT
Trinity, FL 34655-4903
Phone
(727) 688-4400
Fax
(813) 745-8327
NPI assigned
Feb 13, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 2915462 FL Primary

Addresses

Primary practice location

1628 Crossvine CT
Trinity, FL 34655-4903

Mailing address

1628 Crossvine CT
Trinity, FL 34655-4903
Phone (727) 688-4400

Other identifiers 1

IdentifierTypeStateIssuer
001667500MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
2915462FLMDAdult Health Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339372800000",
    "number": "1629246558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1628 CROSSVINE CT",
            "city": "TRINITY",
            "state": "FL",
            "postal_code": "346554903",
            "telephone_number": "727-688-4400",
            "fax_number": "813-745-8327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1628 CROSSVINE CT",
            "city": "TRINITY",
            "state": "FL",
            "postal_code": "346554903",
            "telephone_number": "727-688-4400",
            "fax_number": "813-745-8327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICKSON",
        "first_name": "DONNA",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "ARNP-C MSN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-13",
        "last_updated": "2012-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "2915462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001667500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Trinity, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.