Provider Demographics
NPI:1487002895
Name:MILLARD, LYNN MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:MARIE
Last Name:MILLARD
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:PO BOX 1000294
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0294
Mailing Address - Country:US
Mailing Address - Phone:352-273-7584
Mailing Address - Fax:352-392-3498
Practice Address - Street 1:9030 W FORT ISLAND TRL STE 1
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-8011
Practice Address - Country:US
Practice Address - Phone:352-228-8906
Practice Address - Fax:352-228-8905
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2144172363LF0000X
FLAPRN2144172363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily