Healthcare Provider Details

I. General information

NPI: 1740262492
Provider Name (Legal Business Name): LYNN E MCGRORY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 10/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 GOODLETTE FRANK RD SUITE 160
NAPLES FL
34102-5469
US

IV. Provider business mailing address

671 GOODLETTE FRANK RD SUITE 160
NAPLES FL
34102-5469
US

V. Phone/Fax

Practice location:
  • Phone: 239-331-7782
  • Fax: 239-331-7786
Mailing address:
  • Phone: 239-331-7782
  • Fax: 239-331-7786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberSP004601U
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberARNP9255998
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: