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General NPI Number Information
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NPI Number | 1871398230
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Entity Type | Individual
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Provider Name | TAYLOR CHARLES DIXON
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Gender | Male
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 701 6TH ST S
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4891
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Country | US
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Telephone | 630-770-4727
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Fax |
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Provider Business Mailing Address
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Address Line | 701 6TH ST S
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City | ST PETERSBURG
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State | FL
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Zip | 33701-4814
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Country | US
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Telephone | 727-893-6288
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Fax | 321-843-2196
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN9441278
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | APRN11039747
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License Number State | FL
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