Provider Demographics
NPI:1740774470
Name:LEGAULT, LINDA GAIL (CNM)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:GAIL
Last Name:LEGAULT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 SIROCO LN
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-7600
Mailing Address - Country:US
Mailing Address - Phone:321-312-1494
Mailing Address - Fax:
Practice Address - Street 1:2032 SIROCO LN
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-7600
Practice Address - Country:US
Practice Address - Phone:321-312-1494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-16
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000324367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife