Healthcare Provider Details

I. General information

NPI: 1407804479
Provider Name (Legal Business Name): CYNTHIA H PLATT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 NORTH 9TH AVANUE
PENSACOLA FL
32504
US

IV. Provider business mailing address

305 SOUTH ADAMS STREET
PENSACOLA FL
32502
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-6108
  • Fax: 855-527-5510
Mailing address:
  • Phone: 850-431-5354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2195
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: