Provider Demographics
NPI:1114450657
Name:LECLERC, LYNN A (FNP)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:A
Last Name:LECLERC
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:TOUSSAINT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-695-6071
Mailing Address - Fax:843-569-5879
Practice Address - Street 1:113 WILLBROOK BLVD UNIT F
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-8245
Practice Address - Country:US
Practice Address - Phone:433-536-0158
Practice Address - Fax:843-594-5149
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20845363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4806Medicaid