Thibodeau, Lynn R

Thibodeau, Lynn R is an individual health care provider with primary practice located at 4689 Us Highway 17 Ste 2 , Fleming Island FL 32003-4831. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Thibodeau, Lynn R can be contacted via phone (904) 269-6526.

Contact Information

Primary practice address
4689 Us Highway 17 Ste 2 Fleming Island FL 32003-4831
Phone: (904) 269-6526
Fax: (904) 269-6527
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA9107879 Florida
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA9107879 Florida

Profile Details

NPI number 1811992696
LBN Legal business name Thibodeau, Lynn R
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 17th, 2005
Last updated Jul 10th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1811992696 NPPES
Florida MEDICAID 015211100

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