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General NPI Number Information
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NPI Number | 1255963070
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Entity Type | Individual
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Provider Name | CYNTHIA CHINWENDU CHIAKU
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Gender | Female
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Dates
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Enumeration Date | 02/10/2020
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Last Update Date | 05/09/2024
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Provider Practice Location Address
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Address Line | 5957 ROWAN RD
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City | NEW PORT RICHEY
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State | FL
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Zip | 34653-4531
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Country | US
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Telephone | 352-518-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 5561 SWEET WILLIAM TER
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City | LAND O LAKES
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State | FL
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Zip | 34639-2851
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Country | US
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Telephone | 941-264-5762
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11004581
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11004581
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11004581
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License Number State | FL
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