Healthcare Provider Details

I. General information

NPI: 1972990992
Provider Name (Legal Business Name): CYNTHIA SHAWN HACKBART NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3185 ROUTE 27
FRANKLIN PARK NJ
08823
US

IV. Provider business mailing address

3250 DURHAM PL
HOLLAND PA
18966-2934
US

V. Phone/Fax

Practice location:
  • Phone: 732-422-4889
  • Fax: 732-940-8724
Mailing address:
  • Phone: 267-353-9824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP014756
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00727800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: