MEDICARE: LINDA ELIZABETH WYNN

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	372500000X	Chore Provider
2	372600000X	Adult Companion
3	376J00000X	Homemaker

General Provider Information

NPI Number	:	1790366011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA ELIZABETH WYNN

Provider Business Mailing Address
First Line	:	1155 W STATE ROAD 434 SUITE 115
Second Line	:	# 294
City	:	LONGWOOD
State	:	FL
Zip	:	32750
Country	:	US
Telephone Number	:	864-523-3001
Fax Number	:

Provider Business Practice Location Address
First Line	:	1198 LAKE LUCERNE CIR
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-2333
Country	:	US
Telephone Number	:	864-523-3001
Fax Number	:

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

Provider Enumeration Date	:	04/19/2021
Last Update Date	:	04/19/2021

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Directions to “ LINDA ELIZABETH WYNN ” Practice Location

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