Basic Information
| Provider Information | |||||||||
| NPI: | 1932196680 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUNDAY | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | BLEVINS | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 SOUTH FLORDIA AVENUE | ||||||||
| Address2: | SUITE #210 | ||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338014543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636871222 | ||||||||
| FaxNumber: | 6836036546 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 SOUTH FLORDIA AVENUE | ||||||||
| Address2: | SUITE #210 | ||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338014543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636871222 | ||||||||
| FaxNumber: | 6836036546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 06/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | ARNP1425592 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP0808X | APRN1425592 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.