Healthcare Provider Details

I. General information

NPI: 1376862987
Provider Name (Legal Business Name): LINDA JEAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 S FEDERAL HWY
HOLLYWOOD FL
33020-5424
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

V. Phone/Fax

Practice location:
  • Phone: 954-342-8800
  • Fax: 954-342-8700
Mailing address:
  • Phone: 863-215-6639
  • Fax: 844-388-6186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME114969
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number067653
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: