Provider Demographics
NPI:1366597767
Name:HARRISON, LINDA BUCHANAN
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:BUCHANAN
Last Name:HARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E 6TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3661
Mailing Address - Country:US
Mailing Address - Phone:850-785-3185
Mailing Address - Fax:850-785-6233
Practice Address - Street 1:801 E 6TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3661
Practice Address - Country:US
Practice Address - Phone:850-785-3185
Practice Address - Fax:850-785-6233
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL454122367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP454122OtherFL LIC NUMBER
FLG1528OtherFL BCBS
P00209008OtherMEDICARE RAILROAD
FLG1528OtherFL BCBS