Provider Demographics
NPI:1851545115
Name:DAWN RENE LLC
Entity Type:Organization
Organization Name:DAWN RENE LLC
Other - Org Name:VERNON FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ ARNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:850-535-0703
Mailing Address - Street 1:PO BOX 829
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:FL
Mailing Address - Zip Code:32462-0829
Mailing Address - Country:US
Mailing Address - Phone:850-535-0705
Mailing Address - Fax:
Practice Address - Street 1:3027 MAIN ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:FL
Practice Address - Zip Code:32462-2220
Practice Address - Country:US
Practice Address - Phone:850-535-0703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAR2003622363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10-8989Medicare PIN
FLY905AMedicare PIN
FLK5527Medicare PIN