Provider Demographics
NPI:1609292747
Name:HEDBERG, DONNA LE (ARNP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:LE
Last Name:HEDBERG
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2827
Mailing Address - Country:US
Mailing Address - Phone:321-632-6963
Mailing Address - Fax:321-632-6983
Practice Address - Street 1:119 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2827
Practice Address - Country:US
Practice Address - Phone:321-632-6963
Practice Address - Fax:321-632-6983
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2971002363LF0000X
FLAPRN2971002363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010828500Medicaid
FL010828500Medicaid