Provider Demographics
NPI:1174882799
Name:PEARSON, LINDSEY PUTNAM (APRN)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:PUTNAM
Last Name:PEARSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:SHIRLEY
Other - Last Name:PUTNAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:15255 MAX LEGGETT PARKWAY
Mailing Address - Street 2:SUITE 4400
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218
Mailing Address - Country:US
Mailing Address - Phone:904-427-8898
Mailing Address - Fax:904-383-1893
Practice Address - Street 1:15255 MAX LEGGETT PARKWAY
Practice Address - Street 2:SUITE 4400
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218
Practice Address - Country:US
Practice Address - Phone:904-427-8898
Practice Address - Fax:904-383-1893
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9310493363A00000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003175493AMedicaid
FL005573000Medicaid
FLGH455XMedicare PIN
FL005573000Medicaid