Provider Demographics
NPI:1073573945
Name:DIXON, BRENDA CAROL (ARNP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:CAROL
Last Name:DIXON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 HOSPITAL DR NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5066
Mailing Address - Country:US
Mailing Address - Phone:850-833-9240
Mailing Address - Fax:850-833-9252
Practice Address - Street 1:221 HOSPITAL DR NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5066
Practice Address - Country:US
Practice Address - Phone:850-833-9240
Practice Address - Fax:850-833-9252
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1736202363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL301660900Medicaid
FLP01764Medicare UPIN
FLE3788AMedicare ID - Type Unspecified