Provider Demographics
NPI:1295069847
Name:HAYSLETT, LINDA N (DO)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:N
Last Name:HAYSLETT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7655 38TH AVE N STE 101
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1263
Mailing Address - Country:US
Mailing Address - Phone:273-451-3327
Mailing Address - Fax:727-345-3200
Practice Address - Street 1:7655 38TH AVE N STE 101
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1263
Practice Address - Country:US
Practice Address - Phone:727-345-1332
Practice Address - Fax:727-345-3200
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11742207R00000X
FLUO2196207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008084200Medicaid
FL008084200Medicaid