1639577661 NPI number — CYNTHIA S DEVINE APRN

Table of content: CYNTHIA S DEVINE APRN (NPI 1639577661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639577661 NPI number — CYNTHIA S DEVINE APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEVINE
Provider First Name:
CYNTHIA
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOWELL
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639577661
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4478
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT PIERCE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-678-8447
Provider Business Mailing Address Fax Number:
772-252-4879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMYRNA
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19977-1078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-678-8447
Provider Business Practice Location Address Fax Number:
772-252-4879
Provider Enumeration Date:
12/08/2014

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: 363L00000X , with the licence number:  APN-0001802 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: APRN11004113 , 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: APN-0001802 . This is a "STATE LICENSE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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