Individual
MIRIAM A. DICKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
601 PARK LAKE DR, PONTE VEDRA, FL 32081-0869
(305) 336-6406
(904) 593-9456
Mailing address
601 PARK LAKE DR, PONTE VEDRA, FL 32081-0869
(305) 336-6406
(904) 593-9456
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
ME135925
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024884800
—
FL
Enumeration date
08/05/2014
Last updated
05/08/2026
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