MEDICARE: LYNN MARIE MILLARD APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2144172	FL
2	363L00000X	Nurse Practitioner	APRN2144172	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487002895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN MARIE MILLARD APRN

Provider Business Mailing Address
First Line	:	PO BOX 1000294
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32610-0294
Country	:	US
Telephone Number	:	352-273-7584
Fax Number	:	352-392-3498

Provider Business Practice Location Address
First Line	:	9030 W FORT ISLAND TRL STE 1
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429-8011
Country	:	US
Telephone Number	:	352-228-8906
Fax Number	:	352-228-8905

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2016
Last Update Date	:	09/07/2023

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