1619612645 NPI number — MRS. CYNTHIA JOANN HERMOSILLO FNP-C, APRN

Table of content: MRS. CYNTHIA JOANN HERMOSILLO FNP-C, APRN (NPI 1619612645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619612645 NPI number — MRS. CYNTHIA JOANN HERMOSILLO FNP-C, APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERMOSILLO
Provider First Name:
CYNTHIA
Provider Middle Name:
JOANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C, APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOPEZ
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
JOANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP, APRN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1619612645
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1124 E SAN CARLOS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85249-4712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-299-3761
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3744 S ROME ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85297-7350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-224-9500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2022

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: 163W00000X , with the licence number:  RN217169 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 279889 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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