Healthcare Provider Details

I. General information

NPI: 1639680416
Provider Name (Legal Business Name): LINDA SPENCELEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 10/19/2017
Certification Date: SPENCELEY LINDA 11491 FORTUNE ST SPRING HILL FL 34609 5030 MARINER BLVD SPRING HILL FL 34609
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 MARINER BLVD
SPRING HILL FL
34609-1829
US

IV. Provider business mailing address

11491 FORTUNE ST
SPRING HILL FL
34609-2212
US

V. Phone/Fax

Practice location:
  • Phone: 352-683-9666
  • Fax:
Mailing address:
  • Phone: 352-584-6846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health
License NumberMH9106
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: