Healthcare Provider Details

I. General information

NPI: 1306159801
Provider Name (Legal Business Name): LINSEY JO SEUBERT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E COMMERCIAL BLVD
FORT LAUDERDALE FL
33308-3725
US

IV. Provider business mailing address

1800 E COMMERCIAL BLVD
FORT LAUDERDALE FL
33308-3725
US

V. Phone/Fax

Practice location:
  • Phone: 954-491-2444
  • Fax:
Mailing address:
  • Phone: 954-491-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9015279
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: