Healthcare Provider Details

I. General information

NPI: 1336028596
Provider Name (Legal Business Name): CYNTHIA SARPONG NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2025
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11941 BELSAY RD
GRAND BLANC MI
48439-1702
US

IV. Provider business mailing address

11941 BELSAY RD
GRAND BLANC MI
48439-1702
US

V. Phone/Fax

Practice location:
  • Phone: 734-707-1056
  • Fax:
Mailing address:
  • Phone: 734-707-1056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704348256
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: