Healthcare Provider Details

I. General information

NPI: 1083718704
Provider Name (Legal Business Name): LINDA XUAN DO RN, MS, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 3RD AVE
BRONX NY
10455
US

IV. Provider business mailing address

2825 3RD AVE
BRONX NY
10455-4066
US

V. Phone/Fax

Practice location:
  • Phone: 866-224-4662
  • Fax: 718-509-3584
Mailing address:
  • Phone: 866-224-4662
  • Fax: 718-509-3584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF333916
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberF333916-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberF333916-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: