Provider Demographics
NPI:1194854679
Name:FLYNN, LINDA J (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:J
Last Name:FLYNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 W SWANN AVE
Mailing Address - Street 2:SUITE #300
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4039
Mailing Address - Country:US
Mailing Address - Phone:813-872-9551
Mailing Address - Fax:813-872-9554
Practice Address - Street 1:2605 W SWANN AVE
Practice Address - Street 2:SUITE #300
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4039
Practice Address - Country:US
Practice Address - Phone:813-872-9551
Practice Address - Fax:813-872-9554
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66332207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26291AOtherBCBS
F70200Medicare UPIN
FLK6565Medicare ID - Type Unspecified