Provider Demographics
NPI:1063086577
Name:DAWN SMITH WALSH, APRN-BC, PLLC
Entity type:Organization
Organization Name:DAWN SMITH WALSH, APRN-BC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:813-838-1740
Mailing Address - Street 1:14910 N DALE MABRY HWY # 342203
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-1814
Mailing Address - Country:US
Mailing Address - Phone:813-838-1740
Mailing Address - Fax:
Practice Address - Street 1:14910 N DALE MABRY HWY # 342203
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-1814
Practice Address - Country:US
Practice Address - Phone:813-838-1740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1992030696OtherNPI
FL113873900Medicaid