Healthcare Provider Details

I. General information

NPI: 1033399134
Provider Name (Legal Business Name): CYNTHIA MARIE PETERMANN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E GREENVILLE ST
ANDERSON SC
29621-1529
US

IV. Provider business mailing address

PO BOX 616788
ORLANDO FL
32861-6788
US

V. Phone/Fax

Practice location:
  • Phone: 864-332-3098
  • Fax: 855-232-3959
Mailing address:
  • Phone: 407-447-7120
  • Fax: 407-770-0661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number222000
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number222000
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: