Provider Demographics
NPI:1104583335
Name:OTERO, LINDA J (CNA)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:J
Last Name:OTERO
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7048 52ND LN N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-4314
Mailing Address - Country:US
Mailing Address - Phone:727-512-1113
Mailing Address - Fax:
Practice Address - Street 1:7048 52ND LN N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-4314
Practice Address - Country:US
Practice Address - Phone:727-512-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1922196376K00000X
FL405443376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide