Provider Demographics
NPI:1124176573
Name:PROUGH, LINDA LEE (LPN)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:LEE
Last Name:PROUGH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 CANGRO ST
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926-2227
Mailing Address - Country:US
Mailing Address - Phone:321-639-0929
Mailing Address - Fax:
Practice Address - Street 1:3905 GRISSOM PKWY
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32926-3669
Practice Address - Country:US
Practice Address - Phone:321-637-1866
Practice Address - Fax:321-637-1868
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN1228881164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse