Provider Demographics
NPI:1932420544
Name:DIXON, MANDANA ALBORZFARD (ARNP)
Entity type:Individual
Prefix:MRS
First Name:MANDANA
Middle Name:ALBORZFARD
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 1:380 RINEHART RD
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2551
Mailing Address - Country:US
Mailing Address - Phone:321-842-0266
Mailing Address - Fax:321-842-1852
Practice Address - Street 1:555 W STATE ROAD 434
Practice Address - Street 2:MP SS ADMIN
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5119
Practice Address - Country:US
Practice Address - Phone:321-842-2994
Practice Address - Fax:407-767-5801
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9238785363LF0000X, 363LW0102X, 363LA2200X
FLARNP9238785363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002556100Medicaid
FLARNP9238785OtherMEDICAL LICENSE
FLDJ876XMedicare PIN