Healthcare Provider Details

I. General information

NPI: 1548255490
Provider Name (Legal Business Name): LYNN M MALONE WOMEN'S NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N SYKES CREEK PKWY
MERRITT ISLAND FL
32953-3460
US

IV. Provider business mailing address

150 N SYKES CREEK PKWY
MERRITT ISLAND FL
32953-3460
US

V. Phone/Fax

Practice location:
  • Phone: 321-459-1192
  • Fax: 321-459-2304
Mailing address:
  • Phone: 321-459-1192
  • Fax: 321-459-2304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP 9276440
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN9276440
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: