Provider Demographics
NPI:1689622334
Name:KLETTY, LINDA JOYCE (ARNP-C)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JOYCE
Last Name:KLETTY
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-2937
Mailing Address - Country:US
Mailing Address - Phone:772-567-5326
Mailing Address - Fax:772-567-5326
Practice Address - Street 1:3607 15TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6513
Practice Address - Country:US
Practice Address - Phone:772-562-8522
Practice Address - Fax:772-562-0317
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1014792363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6121YMedicare UPIN