Provider Demographics
NPI:1972199735
Name:DIXON, BRENDA RENNA
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:RENNA
Last Name:DIXON
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:PO BOX 11283
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33419-1283
Mailing Address - Country:US
Mailing Address - Phone:561-667-8099
Mailing Address - Fax:
Practice Address - Street 1:3616 AVENUE K
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-2148
Practice Address - Country:US
Practice Address - Phone:561-667-8099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator