Provider Demographics
NPI:1255361101
Name:SMITH, LYNN M (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:352-340-2115
Mailing Address - Fax:352-340-2116
Practice Address - Street 1:120 MEDICAL BLVD STE 103
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-0221
Practice Address - Country:US
Practice Address - Phone:352-340-2115
Practice Address - Fax:352-340-2116
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9229817363LF0000X
FLAPRN9229817363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily