Healthcare Provider Details

I. General information

NPI: 1376010314
Provider Name (Legal Business Name): LINDA IGBINOBA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N 35TH AVE STE 330
HOLLYWOOD FL
33021-5488
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
PEMBROKE PINES FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 54-265-4325
  • Fax: 954-935-3186
Mailing address:
  • Phone: 954-276-5685
  • Fax: 954-985-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11000393
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberRN10008251
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: