Healthcare Provider Details

I. General information

NPI: 1679023022
Provider Name (Legal Business Name): SALLY RENEE LAWTON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N BONITA AVE
PANAMA CITY FL
32401-3623
US

IV. Provider business mailing address

615 N BONITA AVE
PANAMA CITY FL
32401-3623
US

V. Phone/Fax

Practice location:
  • Phone: 850-747-6591
  • Fax:
Mailing address:
  • Phone: 850-804-6591
  • Fax: 850-804-2418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRNCNP020271
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11014638
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: