Provider Demographics
NPI:1164697231
Name:JONES WILKINSON, LINDSEY JANE
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:JANE
Last Name:JONES WILKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LINDSEY
Other - Middle Name:JANE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:580 SE HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:KEYSTONE HGTS
Mailing Address - State:FL
Mailing Address - Zip Code:32656
Mailing Address - Country:US
Mailing Address - Phone:352-215-1725
Mailing Address - Fax:
Practice Address - Street 1:580 SE HOLLY AVE
Practice Address - Street 2:
Practice Address - City:KEYSTONE HGTS
Practice Address - State:FL
Practice Address - Zip Code:32656
Practice Address - Country:US
Practice Address - Phone:352-215-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41885174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC2759OtherBLUE CROSS BLUE SHEILD