Healthcare Provider Details

I. General information

NPI: 1336717545
Provider Name (Legal Business Name): LINZY GUMP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9679 LAKE NONA VILLAGE PL STE 104
ORLANDO FL
32827-7310
US

IV. Provider business mailing address

9679 LAKE NONA VILLAGE PL STE 104
ORLANDO FL
32827-7310
US

V. Phone/Fax

Practice location:
  • Phone: 407-277-9242
  • Fax: 407-636-7805
Mailing address:
  • Phone: 407-277-9242
  • Fax: 407-636-7805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME173038
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: