Provider Demographics
NPI:1740581172
Name:DIXON-SHERMAN, MEGAN ANN (PA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ANN
Last Name:DIXON-SHERMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 HOSPITAL DR NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5063
Mailing Address - Country:US
Mailing Address - Phone:850-833-7451
Mailing Address - Fax:850-833-7439
Practice Address - Street 1:137 HOSPITAL DR NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5063
Practice Address - Country:US
Practice Address - Phone:850-833-7451
Practice Address - Fax:850-833-7439
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9105527363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY06EHOtherBCBS-FL
FL003066100Medicaid
FL3307780OtherUNITED HEALTH
FL3373914OtherCIGNA
FLEI951ZMedicare PIN