Healthcare Provider Details

I. General information

NPI: 1194704593
Provider Name (Legal Business Name): LYNN LASHAY BEACH CAPT / MC / USN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNN L BEACH M.D.

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST NAVAL HOSPITAL JACKSONVILLE, ATTN: LABORATORY
JACKSONVILLE FL
32214-5005
US

IV. Provider business mailing address

6000 W HIGHWAY 98
PENSACOLA FL
32512-0001
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-7388
  • Fax: 904-542-7399
Mailing address:
  • Phone: 850-505-6253
  • Fax: 850-505-6259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberME142455
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number0101049638
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: