Healthcare Provider Details

I. General information

NPI: 1770650152
Provider Name (Legal Business Name): DAWN WHITE LEGGON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN OUELLETTE WHITE ARNP

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W COLONIAL DR STE 184
OCOEE FL
34761-3434
US

IV. Provider business mailing address

10000 W COLONIAL DR STE 184
OCOEE FL
34761-3434
US

V. Phone/Fax

Practice location:
  • Phone: 407-296-1923
  • Fax: 407-636-7850
Mailing address:
  • Phone: 407-296-1923
  • Fax: 407-636-7850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP3195492
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: