MEDICARE: DAWN RENE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AR2003622	FL

General Provider Information

NPI Number	:	1851545115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAWN RENE LLC

Provider Business Mailing Address
First Line	:	PO BOX 829
Second Line	:
City	:	VERNON
State	:	FL
Zip	:	32462-0829
Country	:	US
Telephone Number	:	850-535-0705
Fax Number	:

Provider Business Practice Location Address
First Line	:	3027 MAIN ST
Second Line	:
City	:	VERNON
State	:	FL
Zip	:	32462-2220
Country	:	US
Telephone Number	:	850-535-0703
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ ARNP
Name	:	MRS. DAWN R FROST
Credential	:	ARNP
Telephone Number	:	850-535-0703

Provider Enumeration Date	:	11/12/2008
Last Update Date	:	11/12/2008

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Directions to “DAWN RENE LLC ” Practice Location

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