Healthcare Provider Details

I. General information

NPI: 1790149367
Provider Name (Legal Business Name): CAROLYN ELIZABETH LINEK-RAJAPAKSHA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. CAROLYN ELIZABETH LINEK

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21758 STATE ROAD 54
LUTZ FL
33549-6921
US

IV. Provider business mailing address

21758 STATE ROAD 54
LUTZ FL
33549-6921
US

V. Phone/Fax

Practice location:
  • Phone: 813-337-7577
  • Fax:
Mailing address:
  • Phone: 813-337-7577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME136867
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME136867
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: