Provider Demographics
NPI:1831117944
Name:CONNOR, LYNE L (APRN)
Entity Type:Individual
Prefix:
First Name:LYNE
Middle Name:L
Last Name:CONNOR
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 1:8395 W OAKLAND PARK BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7301
Mailing Address - Country:US
Mailing Address - Phone:954-741-3335
Mailing Address - Fax:954-368-2081
Practice Address - Street 1:8395 W OAKLAND PARK BLVD STE D
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7301
Practice Address - Country:US
Practice Address - Phone:954-741-3335
Practice Address - Fax:954-368-2081
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2210872363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ56617Medicare UPIN