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NPI Code Detail

MEDICARE: LINDA A WALLS PA C

MEDICARE: LINDA A WALLS PA C
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
1363A00000XPhysician Assistant0010-01649NC
2363AM0700XMedical Physician Assistant0010-01649NC
3363A00000XPhysician AssistantPA9113175FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2XFGIHOTHERFLBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356303200
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINDA A WALLS PA C
Provider Business Mailing Address
First Line : 1550 BARKLEY CIR
Second Line :
City : FORT MYERS
State : FL
Zip : 33907-4539
Country : US
Telephone Number : 239-938-2000
Fax Number : 239-278-0404
Provider Business Practice Location Address
First Line : 1550 BARKLEY CIR
Second Line :
City : FORT MYERS
State : FL
Zip : 33907-4539
Country : US
Telephone Number : 239-938-2000
Fax Number : 239-278-0404
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2006
Last Update Date : 06/01/2023

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Directions to “ LINDA A WALLS PA C” Practice Location

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