Healthcare Provider Details

I. General information

NPI: 1942394978
Provider Name (Legal Business Name): CYNTHIA L. WORRELL-WHITE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7051 HIGHWAY 97
MC DAVID FL
32568-2035
US

IV. Provider business mailing address

7051 HIGHWAY 97
MC DAVID FL
32568-2035
US

V. Phone/Fax

Practice location:
  • Phone: 850-572-4156
  • Fax:
Mailing address:
  • Phone: 850-572-4156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME22026
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC-4429
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: