=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992158182
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDSAY S BLACK ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2016
-----------------------------------------------------
Last Update Date | 03/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1141 SE INDIAN ST STE 101
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34997-5764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-221-7789
-----------------------------------------------------
Fax | 772-597-0063
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1094 MILITARY TRL
-----------------------------------------------------
City | JUPITER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33458-7021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-597-0061
-----------------------------------------------------
Fax | 772-597-0063
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | ARNP 9393187
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------