Provider Demographics
NPI:1053401026
Name:VERVILLE, DAWN RENEE (RRT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:RENEE
Last Name:VERVILLE
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 S HEALTHPARK DR
Mailing Address - Street 2:SUITE #205
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-7603
Mailing Address - Country:US
Mailing Address - Phone:239-985-3580
Mailing Address - Fax:239-985-3589
Practice Address - Street 1:9800 S HEALTHPARK DR
Practice Address - Street 2:SUITE #205
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-7603
Practice Address - Country:US
Practice Address - Phone:239-985-3580
Practice Address - Fax:239-985-3589
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT 42462279P3900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P3900XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredNeonatal/Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887983400Medicaid