Provider Demographics
NPI:1194058172
Name:LINDLAND, PETER (PA-C)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:LINDLAND
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 LAND O LAKES CT
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-3700
Mailing Address - Country:US
Mailing Address - Phone:386-490-6036
Mailing Address - Fax:
Practice Address - Street 1:526 LAND O LAKES CT
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-3700
Practice Address - Country:US
Practice Address - Phone:386-490-6036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101154363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant