Provider Demographics
NPI:1164458865
Name:HARPER-NIMOCK, LYNN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:HARPER-NIMOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11674 TYNDEL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-7472
Mailing Address - Country:US
Mailing Address - Phone:904-260-4843
Mailing Address - Fax:
Practice Address - Street 1:435 CLARK RD STE 303
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-5558
Practice Address - Country:US
Practice Address - Phone:904-764-1707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0046441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine