Provider Demographics
NPI:1205641099
Name:LINZEY, TAYLOR BENJAMIN (FNP-C, ENP-C)
Entity type:Individual
Prefix:MR
First Name:TAYLOR
Middle Name:BENJAMIN
Last Name:LINZEY
Suffix:
Gender:M
Credentials:FNP-C, ENP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 LAKEWALK DR APT 117
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5733
Mailing Address - Country:US
Mailing Address - Phone:925-437-4439
Mailing Address - Fax:
Practice Address - Street 1:5030 LAKEWALK DR APT 117
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5733
Practice Address - Country:US
Practice Address - Phone:925-437-4439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLAPRN11038924363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program