Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0004X | Health Psychologist | 235489 | FL |
NPI | 1477160109 |
---|---|
Provider Name | Linda Mims |
First Address | Gainesville, FL 32641-0707 |
Second Address | Gainesville, FL 32641-0707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2020 |
Last Update Date | 27/09/2020 |