Provider Demographics
NPI:1568151850
Name:FORREST, DAWN (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:FORREST
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 EAGLE HARBOR PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4325
Mailing Address - Country:US
Mailing Address - Phone:904-513-1527
Mailing Address - Fax:
Practice Address - Street 1:1715 EAGLE HARBOR PKWY STE C
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4325
Practice Address - Country:US
Practice Address - Phone:904-513-1527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11026105363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily