Provider Demographics
NPI:1437263258
Name:SHADE, LINDA RUTH (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:RUTH
Last Name:SHADE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 MEADOW RUN LOOP
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-9240
Mailing Address - Country:US
Mailing Address - Phone:251-968-3826
Mailing Address - Fax:
Practice Address - Street 1:4600 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2337
Practice Address - Country:US
Practice Address - Phone:850-494-0065
Practice Address - Fax:850-494-0065
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9175062367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00000521OtherMEDICARE RAILROAD
FLG2822OtherBCBS
FLG2822OtherBCBS