Provider Demographics
NPI:1639734619
Name:DIXON, CHARMAINE LORRAINE (APRN)
Entity type:Individual
Prefix:MISS
First Name:CHARMAINE
Middle Name:LORRAINE
Last Name:DIXON
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4876 N MORSELIFE DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-8022
Mailing Address - Country:US
Mailing Address - Phone:561-868-2999
Mailing Address - Fax:
Practice Address - Street 1:4876 N MORSELIFE DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-8022
Practice Address - Country:US
Practice Address - Phone:561-868-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003819163W00000X, 363LG0600X
FL9204555163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse