Basic Information
Provider Information
NPI: 1003149204
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TRUNDLE
FirstName: DAWN
MiddleName: B
NamePrefix: MRS.
NameSuffix:  
Credential: ARNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2328 MEDICO LN
Address2:  
City: MELBOURNE
State: FL
PostalCode: 329407406
CountryCode: US
TelephoneNumber: 3217330064
FaxNumber:  
Practice Location
Address1: 308 S HARBOR CITY BLVD STE A
Address2:  
City: MELBOURNE
State: FL
PostalCode: 329011500
CountryCode: US
TelephoneNumber: 3217330064
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/08/2009
LastUpdateDate: 09/27/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X14393TNN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LP2300X9351411FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care

No ID Information.


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