Healthcare Provider Details

I. General information

NPI: 1316956394
Provider Name (Legal Business Name): SHERRY SUE LINBACK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 NECTARINE ST
FERNANDINA BEACH FL
32034-4724
US

IV. Provider business mailing address

30 S 4TH ST
FERNANDINA BEACH FL
32034-4272
US

V. Phone/Fax

Practice location:
  • Phone: 904-548-1860
  • Fax: 904-277-7283
Mailing address:
  • Phone: 904-548-1800
  • Fax: 904-277-7286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9201567
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: