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General NPI Number Information
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NPI Number | 1902586761
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Entity Type | Individual
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Provider Name | LYNDA JUSTILIEN-PETTY APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/18/2023
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Last Update Date | 07/18/2023
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Provider Practice Location Address
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Address Line | 580 8TH ST. W TOWER 1, 9TH FLOOR
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City | JACKSONVILLE
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State | FL
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Zip | 32209
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Country | US
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Telephone | 904-383-1022
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Fax |
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Provider Business Mailing Address
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Address Line | 373 HEPBURN RD
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City | ORANGE PARK
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State | FL
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Zip | 32065-5639
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Country | US
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Telephone | 904-483-1206
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN11026937
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11026937
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License Number State | FL
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