Provider Demographics
NPI:1467976423
Name:BLACKSHEAR, DAWN CARNEGIA (MSN, ARNP)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:CARNEGIA
Last Name:BLACKSHEAR
Suffix:
Gender:F
Credentials:MSN, ARNP
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:CARNEGIA
Other - Last Name:BLACKSHEAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:10520 FOREST HILL BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3179
Mailing Address - Country:US
Mailing Address - Phone:561-336-7188
Mailing Address - Fax:561-226-6237
Practice Address - Street 1:10520 FOREST HILL BLVD STE 300
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3179
Practice Address - Country:US
Practice Address - Phone:561-336-7188
Practice Address - Fax:561-226-6237
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9311975363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily