Provider Demographics
NPI:1780099531
Name:REEVES, LINDA GAIL (CNA)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:GAIL
Last Name:REEVES
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:CALLAHAN
Mailing Address - State:FL
Mailing Address - Zip Code:32011-0432
Mailing Address - Country:US
Mailing Address - Phone:904-708-3794
Mailing Address - Fax:904-879-1953
Practice Address - Street 1:613306 RIVER RD
Practice Address - Street 2:
Practice Address - City:CALLAHAN
Practice Address - State:FL
Practice Address - Zip Code:32011-3244
Practice Address - Country:US
Practice Address - Phone:904-708-3794
Practice Address - Fax:904-879-1953
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 207214376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide