Healthcare Provider Details

I. General information

NPI: 1487192506
Provider Name (Legal Business Name): LINDSEY LOUDAKIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6945 SW MELISSA LN
STUART FL
34997-7082
US

IV. Provider business mailing address

6945 SW MELISSA LANE
STUART FL
34997
US

V. Phone/Fax

Practice location:
  • Phone: 561-702-0095
  • Fax:
Mailing address:
  • Phone: 561-702-0095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9310384
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: