Provider Demographics
NPI:1922638931
Name:WHITE, LINDSEY BRADY
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:BRADY
Last Name:WHITE
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 1:24325 NE FIRE BREAK 21
Mailing Address - Street 2:
Mailing Address - City:HOSFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32334-2933
Mailing Address - Country:US
Mailing Address - Phone:321-514-0186
Mailing Address - Fax:
Practice Address - Street 1:24325 NE FIRE BREAK 21
Practice Address - Street 2:
Practice Address - City:HOSFORD
Practice Address - State:FL
Practice Address - Zip Code:32334-2933
Practice Address - Country:US
Practice Address - Phone:321-514-0186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004473363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily