Healthcare Provider Details

I. General information

NPI: 1669450854
Provider Name (Legal Business Name): GLYNNIS J LYONS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13501 ICOT BLVD STE 114
CLEARWATER FL
33760-3729
US

IV. Provider business mailing address

2370 CORPORATE CIR STE 300
HENDERSON NV
89074-7760
US

V. Phone/Fax

Practice location:
  • Phone: 727-754-7880
  • Fax:
Mailing address:
  • Phone: 702-910-3950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS4419
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: