1689731432 NPI number — DR JOAN LYN FAMILY MEDICINE P A

Table of content: (NPI 1689731432)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689731432 NPI number — DR JOAN LYN FAMILY MEDICINE P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR JOAN LYN FAMILY MEDICINE P A
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689731432
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6488 SW 25TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIRAMAR
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33023-2800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-967-0774
Provider Business Mailing Address Fax Number:
954-967-0774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 NW 168TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH MIAMI BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33169-6027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-955-6089
Provider Business Practice Location Address Fax Number:
786-955-6091
Provider Enumeration Date:
01/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LYN
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
YVONNE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
954-967-0774

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  06000059 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 019576700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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