Healthcare Provider Details

I. General information

NPI: 1235669508
Provider Name (Legal Business Name): ALEXANDRIA BOOKER DIXON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 FOWLER GROVE BLVD STE 220
WINTER GARDEN FL
34787-5597
US

IV. Provider business mailing address

2200 FOWLER GROVE BLVD STE 220
WINTER GARDEN FL
34787-5597
US

V. Phone/Fax

Practice location:
  • Phone: 407-656-0042
  • Fax:
Mailing address:
  • Phone: 407-656-0042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME145059
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN24879
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME145059
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: