Provider Demographics
NPI:1932196680
Name:MUNDAY, LINDA BLEVINS (ARNP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:BLEVINS
Last Name:MUNDAY
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 1:500 SOUTH FLORDIA AVENUE
Mailing Address - Street 2:SUITE #210
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-4543
Mailing Address - Country:US
Mailing Address - Phone:863-687-1222
Mailing Address - Fax:683-603-6546
Practice Address - Street 1:500 SOUTH FLORDIA AVENUE
Practice Address - Street 2:SUITE #210
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-4543
Practice Address - Country:US
Practice Address - Phone:863-687-1222
Practice Address - Fax:683-603-6546
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1425592363L00000X
FLAPRN1425592363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP49350Medicare UPIN