Healthcare Provider Details

I. General information

NPI: 1790754117
Provider Name (Legal Business Name): ELIZABETH ANNE DIXON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

362 STATE HIGHWAY 83
DEFUNIAK SPRINGS FL
32433-3800
US

IV. Provider business mailing address

362 STATE HIGHWAY 83
DEFUNIAK SPRINGS FL
32433-3800
US

V. Phone/Fax

Practice location:
  • Phone: 850-892-8015
  • Fax: 850-892-8024
Mailing address:
  • Phone: 850-892-8015
  • Fax: 850-892-8024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2649002
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: