Healthcare Provider Details

I. General information

NPI: 1912303850
Provider Name (Legal Business Name): MR. LYNN LEE JONES JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 SW MCGUIRE TER
LAKE CITY FL
32024-1954
US

IV. Provider business mailing address

468 SW MCGUIRE TER
LAKE CITY FL
32024-1954
US

V. Phone/Fax

Practice location:
  • Phone: 386-438-0680
  • Fax:
Mailing address:
  • Phone: 386-438-0680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number305804
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: