Healthcare Provider Details

I. General information

NPI: 1144925652
Provider Name (Legal Business Name): REGINA LYNN MARTIN-LYNCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11501 PACEYS POND CIR
JACKSONVILLE FL
32222-4913
US

IV. Provider business mailing address

11501 PACEYS POND CIR
JACKSONVILLE FL
32222-4913
US

V. Phone/Fax

Practice location:
  • Phone: 954-857-1946
  • Fax: 904-619-6196
Mailing address:
  • Phone: 954-857-1946
  • Fax: 904-619-6196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: