Healthcare Provider Details

I. General information

NPI: 1992720619
Provider Name (Legal Business Name): LYN JOHNSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7975 LAKE UNDERHILL RD SUITE 200
ORLANDO FL
32822-8202
US

IV. Provider business mailing address

7975 LAKE UNDERHILL RD SUITE 200
ORLANDO FL
32822-8202
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-6830
  • Fax: 407-303-6839
Mailing address:
  • Phone: 407-303-6830
  • Fax: 407-303-6839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS 9447
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: