Provider Demographics
NPI:1851835565
Name:SEYMORE, MARK (LPN)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SEYMORE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 US HIGHWAY 90 E
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:FL
Mailing Address - Zip Code:32234-1727
Mailing Address - Country:US
Mailing Address - Phone:904-615-3121
Mailing Address - Fax:
Practice Address - Street 1:860 US HIGHWAY 90 E
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:FL
Practice Address - Zip Code:32234-1727
Practice Address - Country:US
Practice Address - Phone:904-615-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5173235164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse