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General NPI Number Information
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NPI Number | 1912605395
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Entity Type | Individual
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Provider Name | JACOB LYNCH FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 02/16/2023
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 14254 SR 574
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City | DOVER
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State | FL
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Zip | 33527-4414
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Country | US
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Telephone | 813-653-6100
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Fax | 813-938-6422
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Provider Business Mailing Address
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Address Line | 211 KINGS ROW
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City | SEFFNER
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State | FL
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Zip | 33584-3926
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Country | US
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Telephone | 616-432-4211
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11024484
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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 | 12098
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License Number State | MN
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