Provider Demographics
NPI:1649568320
Name:MATTEOLI, LINDA MARIE (DO,)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:MATTEOLI
Suffix:
Gender:F
Credentials:DO,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 FOX VALLEY DR
Mailing Address - Street 2:STE 104
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779
Mailing Address - Country:US
Mailing Address - Phone:407-902-4912
Mailing Address - Fax:
Practice Address - Street 1:900 FOX VALLEY DR STE 104
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-2551
Practice Address - Country:US
Practice Address - Phone:407-902-4912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13606207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine