Provider Demographics
NPI:1104120021
Name:HILLEBRANDT, DAWN MICHELE (ARNP)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MICHELE
Last Name:HILLEBRANDT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 CENTURY MEDICAL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2100
Mailing Address - Country:US
Mailing Address - Phone:321-268-6868
Mailing Address - Fax:321-267-2713
Practice Address - Street 1:250 HARRISON STREET
Practice Address - Street 2:PARRISH MEDICAL GROUP
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780
Practice Address - Country:US
Practice Address - Phone:321-268-6868
Practice Address - Fax:321-267-2713
Is Sole Proprietor?:No
Enumeration Date:2011-01-06
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9224200363L00000X, 363LF0000X
FLAPRN9224200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004512500Medicaid
FLFT839ZMedicare PIN