Provider Demographics
NPI:1063859338
Name:FLOYD, DIXIE M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DIXIE
Middle Name:M
Last Name:FLOYD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:DIXIE
Other - Middle Name:M
Other - Last Name:FLOYD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:4006 RHETT DR
Mailing Address - Street 2:
Mailing Address - City:OLANTA
Mailing Address - State:SC
Mailing Address - Zip Code:29114-9366
Mailing Address - Country:US
Mailing Address - Phone:843-373-1440
Mailing Address - Fax:
Practice Address - Street 1:4006 RHETT DR
Practice Address - Street 2:
Practice Address - City:OLANTA
Practice Address - State:SC
Practice Address - Zip Code:29114-9366
Practice Address - Country:US
Practice Address - Phone:843-373-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9442P164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse