Individual
MYRLANDE DIXON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5380 HICKORY HOLLOW PKWY, STE 201, ANTIOCH, TN 37013-3117
(615) 891-2070
(615) 891-2056
Mailing address
5380 HICKORY HOLLOW PKWY, STE 201, ANTIOCH, TN 37013-3117
(615) 891-2070
(615) 891-2056
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9108246
FL
363AS0400X
Surgical Physician Assistant
Primary
3055
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1125636
CAREPLUS
FL
01
—
5200868
AETNA
FL
01
—
PA9108246
LICENSE NUMBER
FL
01
—
Y0Q74
BC/BS
FL
Enumeration date
12/18/2014
Last updated
05/12/2017
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