MEDICARE: JAYALAKSHMI MAHALINGAM 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	9341419	FL

General Provider Information

NPI Number	:	1265786024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYALAKSHMI MAHALINGAM ARNP

Provider Business Mailing Address
First Line	:	2352 OKALANI ST
Second Line	:
City	:	PALM SHORES
State	:	FL
Zip	:	32940-7300
Country	:	US
Telephone Number	:	815-508-4616
Fax Number	:	888-506-2822

Provider Business Practice Location Address
First Line	:	2352 OKALANI ST
Second Line	:
City	:	PALM SHORES
State	:	FL
Zip	:	32940-7300
Country	:	US
Telephone Number	:	815-508-4616
Fax Number	:	888-506-2822

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

Provider Enumeration Date	:	11/01/2012
Last Update Date	:	10/15/2014

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