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General NPI Number Information
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NPI Number | 1477146892
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Entity Type | Individual
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Provider Name | AMBER DICKSON
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Gender | Female
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Dates
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Enumeration Date | 02/17/2021
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Last Update Date | 02/17/2021
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Provider Practice Location Address
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Address Line | 179 KINGS WAY
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City | SATELLITE BEACH
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State | FL
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Zip | 32937-3259
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Country | US
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Telephone | 254-244-1660
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Fax |
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Provider Business Mailing Address
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Address Line | 179 KINGS WAY
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City | SATELLITE BEACH
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State | FL
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Zip | 32937-3259
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | D250-012-84-844-0
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License Number State | FL
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