Healthcare Provider Details

I. General information

NPI: 1326095944
Provider Name (Legal Business Name): DAWN RENE', INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 7TH ST STE 2
CHIPLEY FL
32428-1935
US

IV. Provider business mailing address

719 7TH ST STE 2
CHIPLEY FL
32428-1935
US

V. Phone/Fax

Practice location:
  • Phone: 850-676-4287
  • Fax: 850-676-4292
Mailing address:
  • Phone: 850-676-4287
  • Fax: 850-676-4292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAR2003622
License Number StateFL

VIII. Authorized Official

Name: MS. DAWN RENE' FROST
Title or Position: OWNER
Credential: ARNP-BC
Phone: 850-676-4287