Provider Demographics
NPI:1871666214
Name:LYN, JOAN YVONNE (DO)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:YVONNE
Last Name:LYN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:YVONNE
Other - Last Name:CROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6488 SW 25TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2800
Mailing Address - Country:US
Mailing Address - Phone:954-625-5061
Mailing Address - Fax:786-955-6091
Practice Address - Street 1:17 NW 168TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-6027
Practice Address - Country:US
Practice Address - Phone:786-955-6089
Practice Address - Fax:786-955-6091
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9954207QG0300X
FLOS 9954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty