1508139312 NPI number — MRS. CYNTHIA ST. CLAIR ABRAHAM FNP

Table of content: MRS. CYNTHIA ST. CLAIR ABRAHAM FNP (NPI 1508139312)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508139312 NPI number — MRS. CYNTHIA ST. CLAIR ABRAHAM FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABRAHAM
Provider First Name:
CYNTHIA
Provider Middle Name:
ST. CLAIR
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARCHER
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
ST. CLAIR
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP-BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508139312
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2718 LEE BLVD
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
LEHIGH ACRES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33971-1537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-303-9298
Provider Business Mailing Address Fax Number:
239-694-9101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2718 LEE BLVD
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
LEHIGH ACRES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33971-1537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-303-9298
Provider Business Practice Location Address Fax Number:
239-694-9101
Provider Enumeration Date:
02/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  ARNP2601442 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1508139312 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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