Healthcare Provider Details

I. General information

NPI: 1013537448
Provider Name (Legal Business Name): JESSICA MARIE LINAN RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 LAKE WORTH RD
GREENACRES FL
33463-3212
US

IV. Provider business mailing address

702 W BRANCH ST
LANTANA FL
33462-4340
US

V. Phone/Fax

Practice location:
  • Phone: 561-963-3391
  • Fax:
Mailing address:
  • Phone: 561-329-7226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberRPT65325
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: