Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | ARNP1736202 | FL |
NPI | 1073573945 |
---|---|
Provider Name | Brenda Carol Dixon |
First Address | Fort Walton Beach, FL 32548-5066 |
Second Address | Fort Walton Beach, FL 32548-5066 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 06/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
301660900 | (05) | FL |
P01764 | (02) | FL |