MEDICARE: LINET NYARIBO M.D

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	207Q00000X	Family Medicine Physician	163092	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1407389711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINET NYARIBO M.D

Provider Business Mailing Address
First Line	:	2902 17TH ST
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-6009
Country	:	US
Telephone Number	:	407-957-0090
Fax Number	:	407-957-1113

Provider Business Practice Location Address
First Line	:	2902 17TH ST
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34769-6009
Country	:	US
Telephone Number	:	407-957-0090
Fax Number	:	407-957-1113

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

Provider Enumeration Date	:	04/05/2017
Last Update Date	:	09/29/2023

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