Provider Demographics
NPI:1902675598
Name:LYNCH, KORTNIE LYNN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KORTNIE
Middle Name:LYNN
Last Name:LYNCH
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 N DONNELLY ST STE 103
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-6969
Mailing Address - Country:US
Mailing Address - Phone:407-492-9245
Mailing Address - Fax:352-329-4230
Practice Address - Street 1:2110 N DONNELLY ST STE 103
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6969
Practice Address - Country:US
Practice Address - Phone:352-800-1404
Practice Address - Fax:352-329-4230
Is Sole Proprietor?:No
Enumeration Date:2023-12-25
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029846363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health