Provider Demographics
NPI:1457303406
Name:AUGUSTUS, LINUS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:LINUS
Middle Name:
Last Name:AUGUSTUS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4269 WOODHALL CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-6630
Mailing Address - Country:US
Mailing Address - Phone:321-637-3788
Mailing Address - Fax:321-637-3507
Practice Address - Street 1:2900 VETERANS WAY
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-8007
Practice Address - Country:US
Practice Address - Phone:321-637-3921
Practice Address - Fax:321-637-3507
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102857363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9102857OtherPHYSICIAN ASSISTANT