Provider Demographics
NPI:1831700020
Name:LYNS, MIKERLINE
Entity type:Individual
Prefix:
First Name:MIKERLINE
Middle Name:
Last Name:LYNS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 PLAZA REAL STE 275
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-3999
Mailing Address - Country:US
Mailing Address - Phone:561-781-7036
Mailing Address - Fax:561-781-7037
Practice Address - Street 1:10941 WINDING CREEK LN
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-5664
Practice Address - Country:US
Practice Address - Phone:954-336-8483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251X00000XAgenciesSupports Brokerage
No253J00000XAgenciesFoster Care Agency
No253Z00000XAgenciesIn Home Supportive Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities