Provider Demographics
NPI:1033363643
Name:LYNCH, DIANA A (ARNP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:A
Last Name:LYNCH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 SW 24TH ST
Mailing Address - Street 2:MEDICAL ADMINSTRATION
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33315-2643
Mailing Address - Country:US
Mailing Address - Phone:954-467-4822
Mailing Address - Fax:954-760-7798
Practice Address - Street 1:780 SW 24TH ST
Practice Address - Street 2:MEDICAL ADMINSTRATION
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33315-2643
Practice Address - Country:US
Practice Address - Phone:954-467-4822
Practice Address - Fax:954-760-7798
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2574372363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health