Healthcare Provider Details

I. General information

NPI: 1912605395
Provider Name (Legal Business Name): JACOB LYNCH FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14254 SR 574
DOVER FL
33527-4414
US

IV. Provider business mailing address

211 KINGS ROW
SEFFNER FL
33584-3926
US

V. Phone/Fax

Practice location:
  • Phone: 813-653-6100
  • Fax: 813-938-6422
Mailing address:
  • Phone: 616-432-4211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11024484
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12098
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: