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General NPI Number Information
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NPI Number | 1629293790
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Entity Type | Individual
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Provider Name | HARMONY DAWN CHURCH PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 10/21/2011
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Provider Practice Location Address
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Address Line | 2056 CENTRE POINTE LN
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4300
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Country | US
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Telephone | 850-668-6888
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Fax | 850-656-2822
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Provider Business Mailing Address
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Address Line | 2505 HARRISON AVE
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City | PANAMA CITY
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State | FL
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Zip | 32405-4423
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Country | US
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Telephone | 850-766-0869
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Fax | 850-522-8354
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 9103042
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA 9103042
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License Number State | FL
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