Healthcare Provider Details

I. General information

NPI: 1912993353
Provider Name (Legal Business Name): CYNTHIA ANN MARTIN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8934 CONROY WINDERMERE RD
ORLANDO FL
32835-3128
US

IV. Provider business mailing address

1501 SAN PEDRO DR SE BLDG 47 SGOMP/PEDIATRIC CLINIC
ALBUQUERQUE NM
87108-5153
US

V. Phone/Fax

Practice location:
  • Phone: 407-351-0082
  • Fax: 407-374-1637
Mailing address:
  • Phone: 505-846-0001
  • Fax: 505-853-6290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number087000407N2 PNP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9412611
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: