Provider Demographics
NPI:1386842375
Name:LINGO, JEFFREY D (PA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:D
Last Name:LINGO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N ORANGE AVE
Mailing Address - Street 2:SUITE 720
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-1026
Mailing Address - Country:US
Mailing Address - Phone:407-288-8638
Mailing Address - Fax:407-288-8639
Practice Address - Street 1:801 N ORANGE AVE
Practice Address - Street 2:SUITE 720
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-1026
Practice Address - Country:US
Practice Address - Phone:407-288-8638
Practice Address - Fax:407-288-8639
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT9104220363AS0400X
FLPA9104220363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical