Healthcare Provider Details

I. General information

NPI: 1184508335
Provider Name (Legal Business Name): JESSICA DIXON RDMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 08/20/2025
Certification Date: 08/01/2025
Deactivation Date: 08/01/2025
Reactivation Date: 08/20/2025

III. Provider practice location address

11730 N DALE MABRY HWY STE A
TAMPA FL
33618-3511
US

IV. Provider business mailing address

11730 N DALE MABRY HWY STE A
TAMPA FL
33618-3511
US

V. Phone/Fax

Practice location:
  • Phone: 813-600-7241
  • Fax:
Mailing address:
  • Phone: 813-600-7241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number141397
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: