Provider Demographics
NPI:1518944776
Name:WHALEN, LINDA S (PA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:WHALEN
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5233 RICKER RD
Mailing Address - Street 2:#101
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-1438
Mailing Address - Country:US
Mailing Address - Phone:904-425-6963
Mailing Address - Fax:904-674-0155
Practice Address - Street 1:5233 RICKER RD
Practice Address - Street 2:#101
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-1438
Practice Address - Country:US
Practice Address - Phone:904-425-6963
Practice Address - Fax:904-674-0155
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2008-02-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9103976363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant