Provider Demographics
NPI:1275313173
Name:LYNN, BRANNON (FNP)
Entity Type:Individual
Prefix:
First Name:BRANNON
Middle Name:
Last Name:LYNN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 SEVILLA AVE APT 1720
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6068
Mailing Address - Country:US
Mailing Address - Phone:931-218-9290
Mailing Address - Fax:
Practice Address - Street 1:122 SEVILLA AVE APT 1720
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6068
Practice Address - Country:US
Practice Address - Phone:931-218-9290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11027297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily