Provider Demographics
NPI:1629293790
Name:CHURCH, HARMONY DAWN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HARMONY
Middle Name:DAWN
Last Name:CHURCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4423
Mailing Address - Country:US
Mailing Address - Phone:850-766-0869
Mailing Address - Fax:850-522-8354
Practice Address - Street 1:2056 CENTRE POINTE LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4300
Practice Address - Country:US
Practice Address - Phone:850-668-6888
Practice Address - Fax:850-656-2822
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9103042363AS0400X
FLPA 9103042363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ56821Medicare UPIN
FLU6411ZMedicare PIN