Provider Demographics
NPI:1881101251
Name:DEL ROSARIO, LYNN YEBAN (APRN)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:YEBAN
Last Name:DEL ROSARIO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 SAN MARCO BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8567
Mailing Address - Country:US
Mailing Address - Phone:904-253-6910
Mailing Address - Fax:904-253-6964
Practice Address - Street 1:1325 SAN MARCO BLVD STE 300
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8567
Practice Address - Country:US
Practice Address - Phone:904-253-6910
Practice Address - Fax:904-253-6964
Is Sole Proprietor?:No
Enumeration Date:2018-01-06
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9198083363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24258700Medicaid