Healthcare Provider Details

I. General information

NPI: 1477975225
Provider Name (Legal Business Name): LINDSEY L. BROGDON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 HUFFSTETLER DR
EUSTIS FL
32726-8225
US

IV. Provider business mailing address

PO BOX 491000
LEESBURG FL
34749-1000
US

V. Phone/Fax

Practice location:
  • Phone: 352-483-1652
  • Fax:
Mailing address:
  • Phone: 352-315-7537
  • Fax: 352-315-7587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9258754
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAP137190
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9258754
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: