Provider Demographics
NPI:1326095944
Name:DAWN RENE', INC.
Entity Type:Organization
Organization Name:DAWN RENE', INC.
Other - Org Name:VERNON FAMILY HEALTH OF CHIPLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:RENE'
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP-BC
Authorized Official - Phone:850-676-4287
Mailing Address - Street 1:719 7TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-1935
Mailing Address - Country:US
Mailing Address - Phone:850-676-4287
Mailing Address - Fax:850-676-4292
Practice Address - Street 1:719 7TH ST STE 2
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-1935
Practice Address - Country:US
Practice Address - Phone:850-676-4287
Practice Address - Fax:850-676-4292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
FLAR2003622363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108989OtherMEDICARE ID-RIVERBEND
FL306088800Medicaid
FL30289900OtherMEDIPASS
FLY9052OtherBC/BS