Provider Demographics
NPI:1215567540
Name:LINDBERG, CHASTITY LYNN (CBD)
Entity Type:Individual
Prefix:
First Name:CHASTITY
Middle Name:LYNN
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:CBD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4085 ROCKY DR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-3389
Mailing Address - Country:US
Mailing Address - Phone:850-598-1939
Mailing Address - Fax:
Practice Address - Street 1:4085 ROCKY DR
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-3389
Practice Address - Country:US
Practice Address - Phone:850-598-1939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-26
Last Update Date:2020-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula