Provider Demographics
NPI:1821762600
Name:LIN, MARK (APRN)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 NW 14TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-1653
Mailing Address - Country:US
Mailing Address - Phone:305-243-7500
Mailing Address - Fax:305-243-7500
Practice Address - Street 1:1321 NW 14TH ST STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1653
Practice Address - Country:US
Practice Address - Phone:305-243-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9518408363LF0000X
FLAPRN10115591363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily