Provider Demographics
NPI:1952322505
Name:HALL, LINDA C (ARNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:C
Last Name:HALL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 43667
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-3667
Mailing Address - Country:US
Mailing Address - Phone:904-398-3760
Mailing Address - Fax:904-727-3550
Practice Address - Street 1:3225 UNIVERSITY BLVD S STE 104
Practice Address - Street 2:CREDENTIALING DEPARTMENT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2757
Practice Address - Country:US
Practice Address - Phone:904-399-1171
Practice Address - Fax:904-727-3550
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1018722363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01086302OtherRAILROAD MEDICARE
FL308314400Medicaid
FLP01086302OtherRAILROAD MEDICARE