Healthcare Provider Details

I. General information

NPI: 1205641099
Provider Name (Legal Business Name): TAYLOR BENJAMIN LINZEY FNP-C, ENP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 LAKEWALK DR APT 117
WINTER GARDEN FL
34787-5733
US

IV. Provider business mailing address

5030 LAKEWALK DR APT 117
WINTER GARDEN FL
34787-5733
US

V. Phone/Fax

Practice location:
  • Phone: 925-437-4439
  • Fax:
Mailing address:
  • Phone: 925-437-4439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11038924
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: