Provider Demographics
NPI:1295061083
Name:GOLDENBERG, LYNN DANIELLE (PA-C)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:DANIELLE
Last Name:GOLDENBERG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11195 S JOG RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-1829
Mailing Address - Country:US
Mailing Address - Phone:561-733-9690
Mailing Address - Fax:561-733-9626
Practice Address - Street 1:11195 S JOG RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-1829
Practice Address - Country:US
Practice Address - Phone:561-733-9690
Practice Address - Fax:561-733-9626
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104775363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant