Provider Demographics
NPI:1053682617
Name:WALSH, LINDSEY (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10190 SW 3RD STREET
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324
Mailing Address - Country:US
Mailing Address - Phone:954-382-2930
Mailing Address - Fax:954-640-5176
Practice Address - Street 1:300 S PINE ISLAND RD
Practice Address - Street 2:105
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2673
Practice Address - Country:US
Practice Address - Phone:954-382-2930
Practice Address - Fax:954-640-5176
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106380363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical