Individual provider Active NPI

Dawn Renee Frederic, ARNP

  • Family Nurse Practitioner
  • Pensacola, FL
National Provider Identifier
1962851501
Registry record updated Aug 31, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
ARNP9476463 Issued in FL
Practice address
1619 Creighton Rd Ste 1
Pensacola, FL 32504
Phone
(850) 444-4700
Fax
(850) 444-7497
NPI assigned
Jun 5, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 1-147554 AL
Family Nurse Practitioner 363LF0000X ARNP9476463 FL Primary

Addresses

Primary practice location

1619 Creighton Rd Ste 1
Pensacola, FL 32504

Mailing address

1619 Creighton Rd Ste 1
Pensacola, FL 32504-7152
Phone (850) 444-4700

Other identifiers 1

IdentifierTypeStateIssuer
023401500MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, FL2 enrollments
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160712000272 AL Practitioner - Nurse Practitioner 7517259542 Reassigns benefits to 2 organizations
I20180321002749 FL Practitioner - Nurse Practitioner 7517259542

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
ARNP9476463FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Baldwin Emergency Physicians, P.C.. CurrentSince Dec 14, 2017 Accepting new patients

Locations

750 Morphy Ave
Fairhope, AL 36532
Phone (251) 928-2375

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535673600000",
    "number": "1962851501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1619 CREIGHTON RD STE 1",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325047152",
            "telephone_number": "850-444-4700",
            "fax_number": "850-444-7497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1619 CREIGHTON RD STE 1",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "32504",
            "telephone_number": "850-444-4700",
            "fax_number": "850-444-7497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERIC",
        "first_name": "DAWN",
        "middle_name": "RENEE",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-05",
        "last_updated": "2018-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "1-147554",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP9476463",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "023401500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

Verify at the official NPI Registry.