Healthcare Provider Details

I. General information

NPI: 1871666214
Provider Name (Legal Business Name): JOAN YVONNE LYN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOAN YVONNE CROSS DO

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 11/04/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 NW 168TH ST
NORTH MIAMI BEACH FL
33169-6027
US

IV. Provider business mailing address

6488 SW 25TH ST
MIRAMAR FL
33023-2800
US

V. Phone/Fax

Practice location:
  • Phone: 786-955-6089
  • Fax: 786-955-6091
Mailing address:
  • Phone: 954-625-5061
  • Fax: 786-955-6091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberOS9954
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS 9954
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: