Healthcare Provider Details

I. General information

NPI: 1477920296
Provider Name (Legal Business Name): JACKIE-JOE B. LINDO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACKIE-JOE B. LINDO FAMILY NP

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 SILVERSIDE RD STE 111
WILMINGTON DE
19809-1768
US

IV. Provider business mailing address

405 SILVERSIDE RD STE 111
WILMINGTON DE
19809-1768
US

V. Phone/Fax

Practice location:
  • Phone: 302-798-0666
  • Fax: 302-798-2401
Mailing address:
  • Phone: 302-798-0666
  • Fax: 302-798-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberL1-0037657
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG0000878
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0000878
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: