Provider Demographics
NPI:1003457888
Name:MATERNI, LYNSEY
Entity Type:Individual
Prefix:
First Name:LYNSEY
Middle Name:
Last Name:MATERNI
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 1:1917 GLEN MIST CV
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4814
Mailing Address - Country:US
Mailing Address - Phone:407-443-7609
Mailing Address - Fax:
Practice Address - Street 1:1917 GLEN MIST CV
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4814
Practice Address - Country:US
Practice Address - Phone:407-443-7609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004429363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily