Healthcare Provider Details

I. General information

NPI: 1699149781
Provider Name (Legal Business Name): LYNN SPRUNGER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LYNN ANN BETTS APN, FNP-BC

II. Dates (important events)

Enumeration Date: 11/30/2015
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 GRANT ST STE 137
MELBOURNE FL
32901-6006
US

IV. Provider business mailing address

PO BOX 1137
MELBOURNE FL
32902-1137
US

V. Phone/Fax

Practice location:
  • Phone: 321-241-6800
  • Fax: 321-241-6890
Mailing address:
  • Phone: 321-952-9696
  • Fax: 321-952-7937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberC.APN.0002881-C-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9204892
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: