Provider Demographics
NPI:1790754117
Name:DIXON, ELIZABETH ANNE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:DIXON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 STATE HIGHWAY 83
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32433-3800
Mailing Address - Country:US
Mailing Address - Phone:850-892-8015
Mailing Address - Fax:850-892-8024
Practice Address - Street 1:362 STATE HIGHWAY 83
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32433-3800
Practice Address - Country:US
Practice Address - Phone:850-892-8015
Practice Address - Fax:850-892-8024
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2649002363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL302344300Medicaid
FL302344300Medicaid
FLX9294YMedicare ID - Type Unspecified