MEDICARE: LINDA SUE BORKAT R.N.

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	163W00000X	Registered Nurse	1077979	AL
2	163W00000X	Registered Nurse	RN083650	GA
3	363LF0000X	Family Nurse Practitioner	1077979	AL

General Provider Information

NPI Number	:	1457332173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA SUE BORKAT R.N.

Provider Business Mailing Address
First Line	:	PO BOX 2585
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31902-2585
Country	:	US
Telephone Number	:	706-660-8505
Fax Number	:	706-660-9390

Provider Business Practice Location Address
First Line	:	1810 STADIUM DR
Second Line	:	SUITE 220
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-3100
Country	:	US
Telephone Number	:	334-664-0210
Fax Number	:	334-664-0217

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	03/04/2008

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