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NPI Code Detail

MEDICARE: DAWN MICHELLE RUSH-WILDE ARNP

MEDICARE:   DAWN MICHELLE RUSH-WILDE  ARNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerARNP2933822FL

General Provider Information

NPI Number : 1619931664
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAWN MICHELLE RUSH-WILDE ARNP
Provider Business Mailing Address
First Line : 3190 N MCMULLEN BOOTH RD STE 200
Second Line :
City : CLEARWATER
State : FL
Zip : 33761-2013
Country : US
Telephone Number : 813-855-2900
Fax Number : 813-855-2990
Provider Business Practice Location Address
First Line : 3190 N MCMULLEN BOOTH RD STE 200
Second Line :
City : CLEARWATER
State : FL
Zip : 33761-2013
Country : US
Telephone Number : 813-855-2900
Fax Number : 813-855-2990
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2006
Last Update Date : 03/29/2024

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