Healthcare Provider Details

I. General information

NPI: 1578147104
Provider Name (Legal Business Name): DAWN GREENE-PUTULIN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 COURT ST
CLEARWATER FL
33756-5809
US

IV. Provider business mailing address

2985 DREW ST
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 727-447-3041
  • Fax:
Mailing address:
  • Phone: 727-820-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11013298
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: