MEDICARE: LINDA JOYCE KLETTY ARNP-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
1	363LA2200X	Adult Health Nurse Practitioner	ARNP1014792	FL

General Provider Information

NPI Number	:	1689622334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA JOYCE KLETTY ARNP-C

Provider Business Mailing Address
First Line	:	180 8TH AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-2937
Country	:	US
Telephone Number	:	772-567-5326
Fax Number	:	772-567-5326

Provider Business Practice Location Address
First Line	:	3607 15TH AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-6513
Country	:	US
Telephone Number	:	772-562-8522
Fax Number	:	772-562-0317

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	03/09/2010

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