Provider Demographics
NPI:1235207663
Name:BROWN, LINDA LOCKETT (RD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LOCKETT
Last Name:BROWN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 COLLEGE DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-7683
Mailing Address - Country:US
Mailing Address - Phone:904-276-8050
Mailing Address - Fax:904-272-9149
Practice Address - Street 1:151 COLLEGE DR
Practice Address - Street 2:SUITE 6
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-7683
Practice Address - Country:US
Practice Address - Phone:904-276-8050
Practice Address - Fax:904-272-9149
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND510133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
N0072Medicare ID - Type UnspecifiedMEDICARE PROVIDER