Healthcare Provider Details

I. General information

NPI: 1649590894
Provider Name (Legal Business Name): DAWN POTTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 STATE ROAD 590 STE 6A
CLEARWATER FL
33759-2505
US

IV. Provider business mailing address

2916 STAR APPLE CT
PALM HARBOR FL
34684-3618
US

V. Phone/Fax

Practice location:
  • Phone: 727-475-4710
  • Fax:
Mailing address:
  • Phone: 727-475-4710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberAP 1972
License Number StateFL

VIII. Authorized Official

Name: LAURA DAWN POTTER
Title or Position: ACUPUNCTURIST, OWNER
Credential: AP, DIPL. OM
Phone: 727-475-4710