Provider Demographics
NPI:1598806861
Name:NIXON, PAMELA L
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:L
Last Name:NIXON
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 1:910 S 8TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-3744
Mailing Address - Country:US
Mailing Address - Phone:904-491-2001
Mailing Address - Fax:904-491-2017
Practice Address - Street 1:910 S 8TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-3744
Practice Address - Country:US
Practice Address - Phone:904-491-2001
Practice Address - Fax:904-491-2017
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor