MEDICARE: LINDA LOU TISDALE ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ARNP9220367	FL

General Provider Information

NPI Number	:	1215059829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA LOU TISDALE ARNP

Provider Business Mailing Address
First Line	:	215 E 6TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32206-4505
Country	:	US
Telephone Number	:	904-356-1630
Fax Number	:

Provider Business Practice Location Address
First Line	:	1760 EDGEWOOD AVE W
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-7209
Country	:	US
Telephone Number	:	904-301-4900
Fax Number	:	904-924-1773

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/08/2007

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Directions to “ LINDA LOU TISDALE ARNP” Practice Location

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