Provider Demographics
NPI:1912605395
Name:LYNCH, JACOB (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:
Last Name:LYNCH
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 KINGS ROW
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-3926
Mailing Address - Country:US
Mailing Address - Phone:616-432-4211
Mailing Address - Fax:
Practice Address - Street 1:14254 SR 574
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:FL
Practice Address - Zip Code:33527-4414
Practice Address - Country:US
Practice Address - Phone:813-653-6100
Practice Address - Fax:813-938-6422
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11024484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily