Provider Demographics
NPI:1114383197
Name:DR JOAN LYN FAMILY MEDICINE P A
Entity type:Organization
Organization Name:DR JOAN LYN FAMILY MEDICINE P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:LYN
Authorized Official - Suffix:
Authorized Official - Credentials:DO, MPH
Authorized Official - Phone:954-625-5061
Mailing Address - Street 1:17 NW 168TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33169-6027
Mailing Address - Country:US
Mailing Address - Phone:954-625-5061
Mailing Address - Fax:786-955-6091
Practice Address - Street 1:17 NW 168TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-6027
Practice Address - Country:US
Practice Address - Phone:954-625-5061
Practice Address - Fax:786-955-6091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1689731432OtherMEDICARE NPI