Healthcare Provider Details

I. General information

NPI: 1013549906
Provider Name (Legal Business Name): ANDREA D LYNN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 STOCKTON DR
TOMS RIVER NJ
08755-6433
US

IV. Provider business mailing address

10 STOCKTON DR
TOMS RIVER NJ
08755-6433
US

V. Phone/Fax

Practice location:
  • Phone: 732-363-6655
  • Fax:
Mailing address:
  • Phone: 732-379-2835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01001900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: