Healthcare Provider Details

I. General information

NPI: 1245224047
Provider Name (Legal Business Name): MYLINDA ANN HALL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S.W. SAVANNAH AVE.
BRANFORD FL
32008-2744
US

IV. Provider business mailing address

911 S MAIN ST
TRENTON FL
32693-3239
US

V. Phone/Fax

Practice location:
  • Phone: 386-935-3090
  • Fax: 352-463-2726
Mailing address:
  • Phone: 352-463-2374
  • Fax: 352-463-2726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2004002791
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA01611
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9356147
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2004002791
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: