Organization
ERICA L. O'DONNELL DOPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERICA LYNNE O'DONNELL D.O. (PRESIDENT)
(386) 673-0517
Entity
Organization
Contact information
Practice address
1400 HAND AVE, SUITE K, ORMOND BEACH, FL 32174-8194
(386) 673-0517
(386) 671-6458
Mailing address
1400 HAND AVE, SUITE K, ORMOND BEACH, FL 32174-8194
(386) 673-0517
(386) 671-6458
Taxonomy
Speciality
Code
Description
License number
State
207QA0000X
Adolescent Medicine (Family Medicine) Physician
Primary
OS7905
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01768
BLUE CROSS
FL
01
—
7512263
AETNA
FL
01
—
80184473
TRICARE RAILROAD
FL
Enumeration date
08/16/2006
Last updated
08/22/2020
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