Healthcare Provider Details

I. General information

NPI: 1710988472
Provider Name (Legal Business Name): DAWN HOSTETLER MACMILLAN AU.D., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 PALM COAST PKWY SW UNIT 3
PALM COAST FL
32137-4780
US

IV. Provider business mailing address

377 PALM COAST PKWY SW UNIT 3
PALM COAST FL
32137-4780
US

V. Phone/Fax

Practice location:
  • Phone: 386-283-4932
  • Fax: 386-283-4934
Mailing address:
  • Phone: 386-283-4932
  • Fax: 386-283-4934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD003683
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberAUD003683
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License NumberAUD003683
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAUD003683
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: