Basic Information
| Provider Information | |||||||||
| NPI: | 1063428753 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAWTON | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8333 N DAVIS HWY | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325146050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509697979 | ||||||||
| FaxNumber: | 8504769200 | ||||||||
| Practice Location | |||||||||
| Address1: | 8333 NORTH DAVIS HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509697979 | ||||||||
| FaxNumber: | 8504769200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 08/02/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | ARNP 2980612 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | P00372406 | 01 | FL | RAILROAD MEDICARE | OTHER | 301647100 | 05 | FL | MEDICAID |