Healthcare Provider Details

I. General information

NPI: 1780807479
Provider Name (Legal Business Name): LINDA N LOTZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2631 NW 41ST ST SUITE E-5
GAINESVILLE FL
32606-7470
US

IV. Provider business mailing address

2631 NW 41ST ST SUITE E-5
GAINESVILLE FL
32606-7470
US

V. Phone/Fax

Practice location:
  • Phone: 352-371-4900
  • Fax: 352-371-4944
Mailing address:
  • Phone: 352-371-4900
  • Fax: 352-371-4944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY5496
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: