| Doctor Name: | DONNA SHEPHERD ENNIS |
| NPI Number: | 1164625208 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NURSE PRACTITIONER |
| License Number: | ARNP 9200638 |
| Business Practice Address: | 21 W Main Ave Defuniak Springs, FL - 324352529 |
| Business Phone Number: | 8508927332 |
| Business Fax Number: | 8508922405 |
| Mailing Address: | 4485 Furling Ln, DESTIN |
| State: | FL |
| Postal Code: | 325415331 |
| Phone Number: | 8509749545 |
| Fax Number: | |
| NPI Enumeration Date: | 06/07/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | ARNP 9200638 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |