Provider Demographics
NPI:1386537090
Name:DIXON, TATANISHA LAVERNE (BSN, RN, LMT, HNB-BC)
Entity type:Individual
Prefix:
First Name:TATANISHA
Middle Name:LAVERNE
Last Name:DIXON
Suffix:
Gender:F
Credentials:BSN, RN, LMT, HNB-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8312 ARABIAN DUNES PL
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-8603
Mailing Address - Country:US
Mailing Address - Phone:813-244-4099
Mailing Address - Fax:
Practice Address - Street 1:10948 N 56TH ST STE 201
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-3001
Practice Address - Country:US
Practice Address - Phone:813-358-8978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-31
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9514719163WC1500X, 163WD0400X
COMT.0026745225700000X
FLMA106366225700000X, 163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist