Healthcare Provider Details

I. General information

NPI: 1902891252
Provider Name (Legal Business Name): CYNTHIA ANN COHEN RN,FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18102 IRVINE BLVD SUITE 105
TUSTIN CA
92780-3402
US

IV. Provider business mailing address

1310 W STEWART DR SUITE 410
ORANGE CA
92868-3854
US

V. Phone/Fax

Practice location:
  • Phone: 714-832-0510
  • Fax: 714-832-2716
Mailing address:
  • Phone: 714-639-9401
  • Fax: 714-639-7095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14684
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: