Healthcare Provider Details

I. General information

NPI: 1760184071
Provider Name (Legal Business Name): JEFFREY DIXON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST
HARTFORD CT
06102-8000
US

IV. Provider business mailing address

4242 SW 21ST PL APT 42C
GAINESVILLE FL
32607-5499
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-0000
  • Fax:
Mailing address:
  • Phone: 321-360-9769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: