Provider Demographics
NPI:1346242625
Name:LYNN, N SUZANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:N
Middle Name:SUZANNE
Last Name:LYNN
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 1:5220 BELFORT RD STE 130
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6018
Mailing Address - Country:US
Mailing Address - Phone:904-446-3701
Mailing Address - Fax:813-321-6574
Practice Address - Street 1:4321 N MACDILL AVE
Practice Address - Street 2:STE 203
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-873-7615
Practice Address - Fax:813-321-6574
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME455422083P0011X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048592600Medicaid
FL048592600Medicaid
FLD51853Medicare UPIN