| Doctor Name: | TARA DIXON |
| NPI Number: | 1194171892 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP-C |
| License Number: | 9310040 |
| Business Practice Address: | 1817 Cypress Brook Dr 101 Trinity, FL - 346554416 |
| Business Phone Number: | 7278348377 |
| Business Fax Number: | |
| Mailing Address: | 10731 Dowry Ave, TAMPA |
| State: | FL |
| Postal Code: | 336153504 |
| Phone Number: | 7276872484 |
| Fax Number: | |
| NPI Enumeration Date: | 05/11/2016 |
| NPI Last Update Date: | 05/30/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 9310040 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |