MEDICARE: MS. LINDA LAVERNE OTTLEY NP

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	8832	CA
2	363L00000X	Nurse Practitioner	AP104217	TX
3	363L00000X	Nurse Practitioner	5647	MN
4	363L00000X	Nurse Practitioner	14443	CT
5	363L00000X	Nurse Practitioner	R0132242	OK
6	363L00000X	Nurse Practitioner	RN2310658	MA
7	363LF0000X	Family Nurse Practitioner	APRN11022481	FL
8	363LA2200X	Adult Health Nurse Practitioner	8832	CA
9	363LF0000X	Family Nurse Practitioner	SP033398	PA
10	363LF0000X	Family Nurse Practitioner	R088414	MD
11	363LF0000X	Family Nurse Practitioner	RN286333	GA
12	363L00000X	Nurse Practitioner	879334	NV

General Provider Information

NPI Number	:	1629085576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA LAVERNE OTTLEY NP

Provider Business Mailing Address
First Line	:	8472 VIA SONOMA UNIT 30
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92037-2735
Country	:	US
Telephone Number	:	760-212-5172
Fax Number	:

Provider Business Practice Location Address
First Line	:	632 BROADWAY PH
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10012-2614
Country	:	US
Telephone Number	:	800-731-4254
Fax Number	:

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	10/20/2025

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