Provider Demographics
NPI:1902102072
Name:PEARSON, DAWNMARIE E (CPNP)
Entity Type:Individual
Prefix:MS
First Name:DAWNMARIE
Middle Name:E
Last Name:PEARSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4930 E LAKE MARY BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-5003
Mailing Address - Country:US
Mailing Address - Phone:407-322-8645
Mailing Address - Fax:407-322-8645
Practice Address - Street 1:6101 LAKE ELLENOR DR STE 105
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4616
Practice Address - Country:US
Practice Address - Phone:407-322-8645
Practice Address - Fax:407-956-4675
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN102308363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000780887FMedicaid