Provider Demographics
NPI:1346656709
Name:CONDERMAN, LYNNE H (APRN)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:H
Last Name:CONDERMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 BELFORT RD
Mailing Address - Street 2:STE 4015
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6017
Mailing Address - Fax:904-450-6041
Practice Address - Street 1:2 SHIRCLIFF WAY STE 300
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4765
Practice Address - Country:US
Practice Address - Phone:904-308-2006
Practice Address - Fax:904-308-7111
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9247200363L00000X, 363LA2200X
FLARNP9247200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012798500Medicaid
GA003151894AMedicaid
FLHW573ZMedicare PIN
FLHW573YMedicare PIN