Provider Demographics
NPI:1043871544
Name:DIXON, ROSEMARY (G11000111514)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:G11000111514
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2722 E 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33605-4132
Mailing Address - Country:US
Mailing Address - Phone:813-391-8319
Mailing Address - Fax:
Practice Address - Street 1:2722 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605-4132
Practice Address - Country:US
Practice Address - Phone:813-391-8319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLG11000111514374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide