Provider Demographics
NPI:1598775298
Name:TURNER, DIXIE (PA-C)
Entity Type:Individual
Prefix:
First Name:DIXIE
Middle Name:
Last Name:TURNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 COLLEGE DR
Mailing Address - Street 2:SUITE 100-102
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-8530
Mailing Address - Country:US
Mailing Address - Phone:904-298-1994
Mailing Address - Fax:904-298-1973
Practice Address - Street 1:10175 FORTUNE PKWY
Practice Address - Street 2:SUITE 401
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6746
Practice Address - Country:US
Practice Address - Phone:904-519-0008
Practice Address - Fax:904-519-0007
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15410363A00000X
FLPA9104128363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292741100Medicaid
CAP31019Medicare UPIN
FLAK787ZMedicare PIN