Provider Demographics
NPI:1356481535
Name:FALZETTA, LINDA (ARNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:FALZETTA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11150 N 53RD ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-4068
Mailing Address - Country:US
Mailing Address - Phone:813-908-7650
Mailing Address - Fax:813-984-2494
Practice Address - Street 1:11150 N 53RD ST
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-4068
Practice Address - Country:US
Practice Address - Phone:813-908-7650
Practice Address - Fax:813-984-2494
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9237935363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJS73309Medicare UPIN