Provider Demographics
NPI:1174232300
Name:DIXON, TIA DENISE (RN)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:DENISE
Last Name:DIXON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 E HORTTER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2008
Mailing Address - Country:US
Mailing Address - Phone:267-971-4848
Mailing Address - Fax:
Practice Address - Street 1:1015 15TH ST NW STE 600
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-2605
Practice Address - Country:US
Practice Address - Phone:202-743-5817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN659640163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse