Healthcare Provider Details

I. General information

NPI: 1619966009
Provider Name (Legal Business Name): DIXIE ROUTON THOMPSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 GRANDE DR
PENSACOLA FL
32504-8951
US

IV. Provider business mailing address

4900 GRANDE DR
PENSACOLA FL
32504-8951
US

V. Phone/Fax

Practice location:
  • Phone: 850-476-3696
  • Fax: 850-477-3573
Mailing address:
  • Phone: 850-476-3696
  • Fax: 850-477-3573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP1762862
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: