Provider Demographics
NPI:1083971907
Name:DIXON, JACQUELINE VERONICA (NP)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:VERONICA
Last Name:DIXON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4755 WHITE PLAINS RD APT 2C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 FRACISCAN WAY
Practice Address - Street 2:150 GRAYMOOR
Practice Address - City:GARRISON
Practice Address - State:NY
Practice Address - Zip Code:10524
Practice Address - Country:US
Practice Address - Phone:845-335-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-17
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401493363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY569675OtherREGISTERED PROFESSIONAL NURSE