Provider Demographics
NPI:1124221734
Name:LYNCH, JUDITH ELAINE (RD, PA)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ELAINE
Last Name:LYNCH
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Gender:F
Credentials:RD, PA
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Mailing Address - Street 1:1150 US HIGHWAY 41 NW
Mailing Address - Street 2:SUITE 11 & 12
Mailing Address - City:JASPER
Mailing Address - State:FL
Mailing Address - Zip Code:32052-5888
Mailing Address - Country:US
Mailing Address - Phone:386-792-7744
Mailing Address - Fax:386-792-7745
Practice Address - Street 1:915 NOBLES FERRY RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-8463
Practice Address - Country:US
Practice Address - Phone:386-364-1751
Practice Address - Fax:386-364-1761
Is Sole Proprietor?:No
Enumeration Date:2007-06-09
Last Update Date:2014-06-18
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Provider Licenses
StateLicense IDTaxonomies
FL9105408363A00000X, 363A00000X
FLND5728133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered