Provider Demographics
NPI:1407389711
Name:NYARIBO, LINET (MD)
Entity Type:Individual
Prefix:
First Name:LINET
Middle Name:
Last Name:NYARIBO
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 1:2902 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6009
Mailing Address - Country:US
Mailing Address - Phone:407-957-0090
Mailing Address - Fax:407-957-1113
Practice Address - Street 1:2902 17TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6009
Practice Address - Country:US
Practice Address - Phone:407-957-0090
Practice Address - Fax:407-957-1113
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL163092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine