Individual
LYNN C TULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
25 W CRYSTAL LAKE ST, SUITE 200, ORLANDO, FL 32806-4475
(407) 254-2500
(407) 423-2789
Mailing address
25 W CRYSTAL LAKE ST, SUITE 200, ORLANDO, FL 32806-4475
(407) 254-2500
(407) 423-2789
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9103793
FL
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
292718700
—
FL
01
—
P01366212
RAILROAD MEDICARE
FL
01
—
PA9103793
MEDICAL LICENSE
FL
Enumeration date
12/19/2006
Last updated
11/12/2020
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