Provider Demographics
NPI:1982670774
Name:FOX, DAWN KRISTINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:KRISTINE
Last Name:FOX
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:358 STILES AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4012
Mailing Address - Country:US
Mailing Address - Phone:904-264-8311
Mailing Address - Fax:904-264-8377
Practice Address - Street 1:358 STILES AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4012
Practice Address - Country:US
Practice Address - Phone:904-264-8311
Practice Address - Fax:904-264-8377
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7122103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL750152Medicare PIN