Provider Demographics
NPI:1780989715
Name:LINDBLAD, URSULA RAE (NP)
Entity type:Individual
Prefix:MRS
First Name:URSULA
Middle Name:RAE
Last Name:LINDBLAD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1111 12TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-3001
Mailing Address - Country:US
Mailing Address - Phone:305-294-3458
Mailing Address - Fax:305-294-8432
Practice Address - Street 1:11216 SUNRISE BLVD E STE 3-207
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-8848
Practice Address - Country:US
Practice Address - Phone:253-770-3700
Practice Address - Fax:253-435-7019
Is Sole Proprietor?:No
Enumeration Date:2011-01-23
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11027517363L00000X
WI4318033363L00000X
WAAP61605142363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2301851Medicaid
WI005150135Medicare PIN