Provider Demographics
NPI:1033279989
Name:DEESE, LINDA S (ARNP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:DEESE
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 1:4756 SCENICVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-8173
Mailing Address - Country:US
Mailing Address - Phone:850-237-3000
Mailing Address - Fax:850-237-3001
Practice Address - Street 1:20370 NE BURNS AVE
Practice Address - Street 2:
Practice Address - City:BLOUNTSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32424-1045
Practice Address - Country:US
Practice Address - Phone:850-237-3000
Practice Address - Fax:850-237-3001
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP679602363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0335592 00Medicaid
FL0335592 00Medicaid
FLY3986ZMedicare ID - Type Unspecified