Healthcare Provider Details

I. General information

NPI: 1376414235
Provider Name (Legal Business Name): CYNTHIA A SPENCER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 04/12/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4415 WESTBROOK RD
BARTLETT TN
38135-1307
US

IV. Provider business mailing address

4415 WESTBROOK RD
BARTLETT TN
38135-1307
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF04260085
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: