Provider Demographics
NPI:1629685201
Name:DEKOLD, LYNDA WILKES
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:WILKES
Last Name:DEKOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 SW 63RD BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-3924
Mailing Address - Country:US
Mailing Address - Phone:352-262-4110
Mailing Address - Fax:
Practice Address - Street 1:4110 SW 63RD BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-3924
Practice Address - Country:US
Practice Address - Phone:352-262-4110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant