Provider Demographics
NPI:1104070903
Name:KOWALCZYK, LINDA (ARNP)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:KOWALCZYK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 NE 47TH ST
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7134
Mailing Address - Country:US
Mailing Address - Phone:954-946-0698
Mailing Address - Fax:
Practice Address - Street 1:690 MEADOWS RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2344
Practice Address - Country:US
Practice Address - Phone:561-955-2547
Practice Address - Fax:561-955-4444
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP967162363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily