Provider Demographics
NPI:1548046758
Name:DIXON, DERRICKA SHAURICE (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:DERRICKA
Middle Name:SHAURICE
Last Name:DIXON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5261 W HILLSBORO BLVD APT 102
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4547
Mailing Address - Country:US
Mailing Address - Phone:954-516-4655
Mailing Address - Fax:
Practice Address - Street 1:5261 W HILLSBORO BLVD APT 102
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4547
Practice Address - Country:US
Practice Address - Phone:954-516-4655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11028370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily