Provider Demographics
NPI:1801209465
Name:FLOYD, LINDA GAYLE
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:GAYLE
Last Name:FLOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:GAYLE
Other - Last Name:FLOYD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:2502B JERRY JONES DR APT 25
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1279
Mailing Address - Country:US
Mailing Address - Phone:229-274-4210
Mailing Address - Fax:
Practice Address - Street 1:2502B JERRY JONES DR APT 25
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1279
Practice Address - Country:US
Practice Address - Phone:229-274-4210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN060566103TC0700X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical