Basic Information
| Provider Information | |||||||||
| NPI: | 1801323035 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ST. HILAIRE | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 INTERNATIONAL PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | LAKE MARY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327465028 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 514 S HUNT CLUB BLVD | ||||||||
| Address2: | |||||||||
| City: | APOPKA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327034948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076132335 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2017 | ||||||||
| LastUpdateDate: | 05/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106E00000X | 0-17-8210 | FL | Y |
ID Information
| ID | Type | State | Issuer | Description | 1639320203 | 01 | FL | CORPORATE NPI TYPE 2 | OTHER | 009093700 | 05 | FL | MEDICAID |