Provider Demographics
NPI:1477661072
Name:LINDO, LIANE MARIE (PA-C,, MMS)
Entity type:Individual
Prefix:
First Name:LIANE
Middle Name:MARIE
Last Name:LINDO
Suffix:
Gender:F
Credentials:PA-C,, MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5780 S UNIVERSITY DR
Mailing Address - Street 2:102
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-6103
Mailing Address - Country:US
Mailing Address - Phone:786-262-2685
Mailing Address - Fax:954-434-1108
Practice Address - Street 1:13221 SW 42ND ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3109
Practice Address - Country:US
Practice Address - Phone:305-829-4240
Practice Address - Fax:305-829-4240
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103546363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9103546OtherSTATE LICENSE