Provider Demographics
NPI:1265786024
Name:MAHALINGAM, JAYALAKSHMI (ARNP)
Entity type:Individual
Prefix:
First Name:JAYALAKSHMI
Middle Name:
Last Name:MAHALINGAM
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 1:2352 OKALANI ST
Mailing Address - Street 2:
Mailing Address - City:PALM SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7300
Mailing Address - Country:US
Mailing Address - Phone:815-508-4616
Mailing Address - Fax:888-506-2822
Practice Address - Street 1:2352 OKALANI ST
Practice Address - Street 2:
Practice Address - City:PALM SHORES
Practice Address - State:FL
Practice Address - Zip Code:32940-7300
Practice Address - Country:US
Practice Address - Phone:815-508-4616
Practice Address - Fax:888-506-2822
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9341419363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily