Provider Demographics
NPI:1659197317
Name:MCCULLOUGH, LINDSAY (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:
Last Name:MCCULLOUGH
Suffix:
Gender:
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4648 JERRILYN CT
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-6724
Mailing Address - Country:US
Mailing Address - Phone:727-808-1606
Mailing Address - Fax:
Practice Address - Street 1:2650 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-2575
Practice Address - Country:US
Practice Address - Phone:727-808-1606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-27
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11035709363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily