Provider Demographics
NPI:1891711842
Name:GROSVENOR, LYNN L (PA-C)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:L
Last Name:GROSVENOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:L
Other - Last Name:GROSVENOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C, MPAS
Mailing Address - Street 1:8687 SW 61ST LOOP
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34481-6454
Mailing Address - Country:US
Mailing Address - Phone:404-538-0402
Mailing Address - Fax:
Practice Address - Street 1:8687 SW 61ST LOOP
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-6454
Practice Address - Country:US
Practice Address - Phone:404-538-0402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003824363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant