Provider Demographics
NPI:1548255490
Name:MALONE, LYNN M (WOMEN'S NP)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:MALONE
Suffix:
Gender:F
Credentials:WOMEN'S NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N SYKES CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3460
Mailing Address - Country:US
Mailing Address - Phone:321-459-1192
Mailing Address - Fax:321-459-2304
Practice Address - Street 1:150 N SYKES CREEK PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3460
Practice Address - Country:US
Practice Address - Phone:321-459-1192
Practice Address - Fax:321-459-2304
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9276440363LX0001X
FLAPRN9276440363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN