Provider Demographics
NPI:1104267137
Name:DIXON, ELOISE G (NRCMA)
Entity type:Individual
Prefix:
First Name:ELOISE
Middle Name:G
Last Name:DIXON
Suffix:
Gender:F
Credentials:NRCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 CLAY CIR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234-6313
Mailing Address - Country:US
Mailing Address - Phone:941-677-0075
Mailing Address - Fax:941-343-2545
Practice Address - Street 1:3003 CLAY CIR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-6313
Practice Address - Country:US
Practice Address - Phone:941-677-0075
Practice Address - Fax:941-343-2545
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL003801253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care