Healthcare Provider Details

I. General information

NPI: 1477505733
Provider Name (Legal Business Name): CINDY MARIE COOK IDC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 W HIGHWAY 98
PENSACOLA FL
32512-0001
US

IV. Provider business mailing address

5067 CHALLENGER WAY
PENSACOLA FL
32507-9197
US

V. Phone/Fax

Practice location:
  • Phone: 850-452-8970
  • Fax: 850-452-8978
Mailing address:
  • Phone: 850-554-0975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: