Provider Demographics
NPI:1104833318
Name:PALMER, LINDA JANE (DPM)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JANE
Last Name:PALMER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4887
Mailing Address - Country:US
Mailing Address - Phone:813-685-3668
Mailing Address - Fax:813-685-5430
Practice Address - Street 1:1149 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4887
Practice Address - Country:US
Practice Address - Phone:813-685-3668
Practice Address - Fax:813-685-5430
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2868213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010404200Medicaid
FLE4334SMedicare ID - Type Unspecified
U81001Medicare UPIN