Provider Demographics
NPI:1760781017
Name:MILLICAN, DIXIE JEAN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:DIXIE
Middle Name:JEAN
Last Name:MILLICAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CALLE PORTAL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2900
Mailing Address - Country:US
Mailing Address - Phone:520-458-0660
Mailing Address - Fax:520-458-9550
Practice Address - Street 1:155 CALLE PORTAL
Practice Address - Street 2:SUITE 200
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2900
Practice Address - Country:US
Practice Address - Phone:520-458-0660
Practice Address - Fax:520-458-9550
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3976363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily