Healthcare Provider Details

I. General information

NPI: 1700360187
Provider Name (Legal Business Name): DAWN WETZEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MICCOSUKEE RD
TALLAHASSEE FL
32308-5054
US

IV. Provider business mailing address

6734 CHEVY WAY
TALLAHASSEE FL
32317-7492
US

V. Phone/Fax

Practice location:
  • Phone: 850-385-0144
  • Fax:
Mailing address:
  • Phone: 352-636-0492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberPENDING
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: