Healthcare Provider Details

I. General information

NPI: 1689287831
Provider Name (Legal Business Name): CYNTHIA MARIE SILVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 OLD BARTOW EAGLE LAKE RD
BARTOW FL
33830-3369
US

IV. Provider business mailing address

142 HARRINGTON CT
DAVENPORT FL
33837-8986
US

V. Phone/Fax

Practice location:
  • Phone: 863-800-3741
  • Fax: 862-800-3741
Mailing address:
  • Phone: 773-962-1089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number11004395
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberARNP11004395
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11004395
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: