Provider Demographics
NPI:1023001633
Name:BEAGLE, LINDA K (ARNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:K
Last Name:BEAGLE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S HYDE PARK AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-4125
Mailing Address - Country:US
Mailing Address - Phone:813-259-1013
Mailing Address - Fax:813-254-0396
Practice Address - Street 1:300 S HYDE PARK AVE
Practice Address - Street 2:STE 210
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-4125
Practice Address - Country:US
Practice Address - Phone:813-259-1013
Practice Address - Fax:813-254-0396
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1624212363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL500025344OtherRAILROAD MEDICARE
FL500027748OtherRAILROAD MEDICARE
FL500028922OtherRAILROAD MEDICARE
FL302019300Medicaid
FLY6016OtherBC/BS FLA
FL500027748OtherRAILROAD MEDICARE
FLY60616YMedicare PIN
FLY6016CMedicare PIN
FL302019300Medicaid
FLY6016ZMedicare PIN
FLY6016AMedicare PIN