MIRIAM ALTAGRACIA DICKSON (NPI# 1669881470) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669881470 |
| Entity Type | Individual |
| Full Name | MIRIAM ALTAGRACIA DICKSON |
| Credential | M.D. |
| Practice Address |
807 Childrens Way Jacksonville FL 32207 |
| Mailing Address |
10140 Centurion Pkwy N Jacksonville FL 32256-0532 |
| Practice Telephone | 9046973600 |
| Practice Fax Number | 9046973927 |
| Mailing Telephone | 9046974127 |
| Mailing Fax Number | 9046975102 |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2018-10-19 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
ME135925 | FL | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | TRN18658 | FL | Student, Health Care |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 024884800 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1740 W Taylor St, Chicago, IL 606127232 | 8666002273 |
| Street Address |
807 CHILDRENS WAY |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32207 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740281658 | Elizabeth A Moran | Orthopaedic Surgery | 807 Childrens Way, Jacksonville, FL 32207-8426 | 2005-08-02 |
| 1689229213 | Madyson Marie Hund | Audiologist | 807 Childrens Way, Jacksonville, FL 32207-8426 | 2019-08-09 |
| 1336792829 | Graciela Teresita Gallo | Psychiatry & Neurology | 807 Childrens Way, Jacksonville, FL 32207-8426 | 2019-07-23 |
| 1538712013 | Vanessa V Oliveira Valente | Surgery | 807 Childrens Way, Jacksonville, FL 32207-8426 | 2019-07-23 |
| 1679031181 | Navondria Lawson | Nurse Practitioner | 807 Childrens Way, Jacksonville, FL 32207-8426 | 2019-03-05 |
| 1952870644 | Jessica Alice Johnson | Nurse Practitioner | 807 Childrens Way, Jacksonville, FL 32207-8426 | 2018-11-25 |
| 1831676584 | Lukas Scott Hayden | Physician Assistant | 807 Childrens Way, Jacksonville, FL 32207-8426 | 2018-07-25 |
| 1053807750 | Christine Nichole Crews | Psychiatry & Neurology | 807 Childrens Way, Jacksonville, FL 32207-8426 | 2018-07-05 |
| 1134610470 | Rocio Krystal Rivera-valentin | Student in an Organized Health Care Education/Training Program | 807 Childrens Way, Jacksonville, FL 32207-8426 | 2018-05-22 |
| 1144726696 | Paige Marie Ryan | Student in an Organized Health Care Education/Training Program | 807 Childrens Way, Jacksonville, FL 32207-8426 | 2018-04-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033768981 | North Florida Pediatrics, Pa | Pediatrics | 4501 Atlantic Boulevard, Jacksonville, FL 32207 | 2019-09-04 |
| 1578117024 | Pragna Mukesh Dholakia | Nurse Practitioner | 2624 Atlantic Blvd., Jacksonville, FL 32207 | 2019-08-01 |
| 1821653601 | The Adoption Authority, Inc. | Case Management | 4940 Emerson Street, Suite 103, Jacksonville, FL 32207 | 2019-05-07 |
| 1255896080 | Elizabeth Lynn Houghton | Social Worker | Sulzbacher Village, 904-720-2079, Jacksonville, FL 32207 | 2019-02-06 |
| 1902374630 | Guilherme Jose Agnoletto | Neurological Surgery | 800 Prudential Drive Weaver Tower 11th Floor, Jacksonville, FL 32207 | 2018-11-12 |
| 1073008504 | Pavilion Infusion Therapy Inc | Durable Medical Equipment & Medical Supplies | 1301 Palm Avenue, Suite 220, Jacksonville, FL 32207 | 2018-06-27 |
| 1346733185 | Dueseason1 | Registered Nurse | 4058 Saint Augustine Rd, Jacksonville, FL 32207 | 2018-06-06 |
| 1164911913 | Eric Lang Poovey | Nurse Practitioner | Baptist Heart Specialists, 836 Prudential Drive Suite 1700, Jacksonville, FL 32207 | 2018-05-08 |
| 1902311046 | Spring Park Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 3851 Emerson St Ste 13, Jacksonville, FL 32207 | 2017-12-12 |
| 1295247948 | Emed Urgent and Primary Care Pa | Clinic/Center | 2570 Atlantic Boulevard, Jacksonville, FL 32207 | 2017-11-02 |
| Find all providers in zip 32207 | ||||
| Taxonomy Code | 2084P0804X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Child & Adolescent Psychiatry |
| Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548490527 | Jusleen C Kendhari | Psychiatry & Neurology | 1650 Prudential Dr Ste 201, Jacksonville, FL 32207-8149 | 2009-07-23 |
| 1053807750 | Christine Nichole Crews | Psychiatry & Neurology | 807 Childrens Way, Jacksonville, FL 32207-8426 | 2018-07-05 |
| 1033567797 | Shirley Diana Angela Alleyne | Psychiatry & Neurology | 580 W 8th St, 580 West 8th Street, Jacksonville, FL 32209-6533 | 2016-06-02 |
| 1083073092 | Chirag V Desai Md LLC | Psychiatry & Neurology | 9191 R G Skinner Pkwy, Jacksonville, FL 32256-9655 | 2016-02-18 |
| 1003200247 | Aylin Saner Emmert | Psychiatry & Neurology | 1650 Prudential Dr Ste 210, Jacksonville, FL 32207-8149 | 2015-03-25 |
| 1871801787 | Fact Specialized Services, Inc. | Psychiatry & Neurology | 127 Center St, Jacksonville, NC 28546-5708 | 2010-09-14 |
| 1528249125 | Blazen Draguljic | Psychiatry & Neurology | 820 Prudential Dr Ste 510, Jacksonville, FL 32207-8207 | 2007-11-25 |
| 1871793869 | Anoosh Salman | Psychiatry & Neurology | 1600 W Walnut St, Jacksonville, IL 62650-1136 | 2007-07-19 |
| 1992914659 | Laurie Ann Truog | Psychiatry & Neurology | 5776 Saint Augustine Rd, Jacksonville, FL 32207-8030 | 2007-05-21 |
| 1831245265 | Kamalesh Kochikar Pai | Psychiatry & Neurology | 8833 Perimeter Park Blvd, Suite 503, Jacksonville, FL 32216 | 2007-01-26 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32207 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.