Healthcare Provider Details

I. General information

NPI: 1073950002
Provider Name (Legal Business Name): JEAN COZAD LYON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 GULF BREEZE PKWY STE 18
GULF BREEZE FL
32561-4492
US

IV. Provider business mailing address

5751 HEATHERTON RD STE A
MILTON FL
32570-7782
US

V. Phone/Fax

Practice location:
  • Phone: 775-885-6940
  • Fax:
Mailing address:
  • Phone: 775-771-0346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11036611
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: