Provider Demographics
NPI:1720103336
Name:DUNN, TIWANNA G (LMT)
Entity Type:Individual
Prefix:
First Name:TIWANNA
Middle Name:G
Last Name:DUNN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 E 12TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2801
Mailing Address - Country:US
Mailing Address - Phone:850-814-1121
Mailing Address - Fax:
Practice Address - Street 1:2101 NORTHSIDE DR UNIT 402
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3687
Practice Address - Country:US
Practice Address - Phone:850-215-8397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA37224174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC2714OtherBCBS