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NPI Code Detail

MEDICARE: LYNETTE TYSON APRN

MEDICARE: LYNETTE TYSON APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAPRN11046090FL

General Provider Information

NPI Number : 1558219642
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNETTE TYSON APRN
Provider Business Mailing Address
First Line : 23476 NW 186TH AVE
Second Line :
City : HIGH SPRINGS
State : FL
Zip : 32643-0673
Country : US
Telephone Number : 386-454-0698
Fax Number : 386-454-0690
Provider Business Practice Location Address
First Line : 922 E CALL ST STE 100
Second Line :
City : STARKE
State : FL
Zip : 32091-3616
Country : US
Telephone Number : 904-364-2900
Fax Number : 904-364-2901
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2026
Last Update Date : 03/17/2026

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