Provider Demographics
NPI:1760505457
Name:FORD, LINDA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 LONE FOX CT
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-9665
Mailing Address - Country:US
Mailing Address - Phone:561-633-9913
Mailing Address - Fax:
Practice Address - Street 1:9400 UNIVERSITY PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5752
Practice Address - Country:US
Practice Address - Phone:850-208-6285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9101814363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9101814OtherPA LICENSE
FLP97015Medicare UPIN