Provider Demographics
NPI:1164582615
Name:RENSHAW, LINDA DIANE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:DIANE
Last Name:RENSHAW
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:DIANE
Other - Last Name:LEADBETTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4943
Practice Address - Street 1:3050 1ST AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-1010
Practice Address - Country:US
Practice Address - Phone:727-321-4846
Practice Address - Fax:727-321-3811
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1570652363LF0000X
FLARNP1570652363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004121000Medicaid
FLAE795Medicare PIN