Healthcare Provider Details

I. General information

NPI: 1649716408
Provider Name (Legal Business Name): CYNDA ST CERE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23040 PANAMA CITY BEACH PKWY
PANAMA CITY BEACH FL
32413
US

IV. Provider business mailing address

PO BOX 11407
BIRMINGHAM AL
35246-1431
US

V. Phone/Fax

Practice location:
  • Phone: 850-770-3230
  • Fax: 850-770-3235
Mailing address:
  • Phone: 361-572-0333
  • Fax: 361-703-5101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9355683
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: