Healthcare Provider Details

I. General information

NPI: 1033253935
Provider Name (Legal Business Name): LYNDA LINDE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNDA BLYTHE CRNA

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W STATE ROAD 434
LONGWOOD FL
32750-5119
US

IV. Provider business mailing address

7700 W SUNRISE BLVD PL-14-MAIL
PLANTATION FL
33322-4113
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-2584
  • Fax: 407-896-9585
Mailing address:
  • Phone: 954-838-2371
  • Fax: 954-851-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9243205
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: