Provider Demographics
NPI:1164128732
Name:DIXON, LATOYA SHAWNTA
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:SHAWNTA
Last Name:DIXON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 PALM KEY CIR APT 303
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4673
Mailing Address - Country:US
Mailing Address - Phone:813-970-5799
Mailing Address - Fax:
Practice Address - Street 1:305 PALM KEY CIR APT 303
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4673
Practice Address - Country:US
Practice Address - Phone:813-970-5799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic