Provider Demographics
NPI:1447663356
Name:FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE
Entity type:Organization
Organization Name:FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GME MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DONOHOE
Authorized Official - Suffix:
Authorized Official - Credentials:MPD
Authorized Official - Phone:850-645-6867
Mailing Address - Street 1:5045 CARPENTER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2521
Mailing Address - Country:US
Mailing Address - Phone:850-416-2418
Mailing Address - Fax:850-416-2460
Practice Address - Street 1:5045 CARPENTER CREEK DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2521
Practice Address - Country:US
Practice Address - Phone:850-416-2418
Practice Address - Fax:850-416-2460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN20051282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital