Healthcare Provider Details

I. General information

NPI: 1609805688
Provider Name (Legal Business Name): MS. LINDA EATON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3941 68TH AVE N
PINELLAS PARK FL
33781-6136
US

IV. Provider business mailing address

P.O. BOX 132
PINELLAS PARK FL
33780
US

V. Phone/Fax

Practice location:
  • Phone: 727-423-7811
  • Fax: 727-865-5178
Mailing address:
  • Phone: 727-423-7811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH5534
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: