Healthcare Provider Details

I. General information

NPI: 1104735109
Provider Name (Legal Business Name): LINETTE SLGI LEE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6954 TREYMONT DR
LAKELAND FL
33813-4011
US

IV. Provider business mailing address

6954 TREYMONT DR
LAKELAND FL
33813-4011
US

V. Phone/Fax

Practice location:
  • Phone: 863-838-1646
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11050726
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: