Provider Demographics
NPI:1073511283
Name:ROLLINS, LYNNE S (RNC, APRN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:S
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:RNC, APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6345 REINHARDT COLLEGE PKWY
Mailing Address - Street 2:
Mailing Address - City:WALESKA
Mailing Address - State:GA
Mailing Address - Zip Code:30183-3257
Mailing Address - Country:US
Mailing Address - Phone:770-479-4613
Mailing Address - Fax:
Practice Address - Street 1:3 BROAD ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-3017
Practice Address - Country:US
Practice Address - Phone:706-295-6701
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN037833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAS07047Medicare UPIN
GA50BBGZQMedicare ID - Type Unspecified