Healthcare Provider Details

I. General information

NPI: 1558297283
Provider Name (Legal Business Name): LYNN NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4245 N COURTENAY PKWY
MERRITT ISLAND FL
32953-8198
US

IV. Provider business mailing address

4245 N COURTENAY PKWY
MERRITT ISLAND FL
32953-8198
US

V. Phone/Fax

Practice location:
  • Phone: 772-469-6909
  • Fax:
Mailing address:
  • Phone: 321-360-7469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN31834
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: