Provider Demographics
NPI:1033217823
Name:CARLSON, LINDA JAN (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:JAN
Last Name:CARLSON
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 1:606 LA SALLE DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-1322
Mailing Address - Country:US
Mailing Address - Phone:407-774-7758
Mailing Address - Fax:
Practice Address - Street 1:5467 RONALD REAGAN BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-6332
Practice Address - Country:US
Practice Address - Phone:407-324-3036
Practice Address - Fax:407-324-3045
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL930872363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL311901700Medicaid