Provider Demographics
NPI:1043278708
Name:BUCKLEY, LINDA (ARNP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:BUCKLEY
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:PO BOX 863407
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3407
Mailing Address - Country:US
Mailing Address - Phone:941-917-2600
Mailing Address - Fax:941-917-7884
Practice Address - Street 1:1515 S OSPREY AVE
Practice Address - Street 2:SUITE 1-A
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2939
Practice Address - Country:US
Practice Address - Phone:941-917-7197
Practice Address - Fax:941-917-4016
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL358032363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306719000Medicaid
FLY8355OtherBCBS
FLY8355YMedicare PIN
FLY83552Medicare PIN
FLP03268Medicare UPIN