=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316502081
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA ANN NEVILLE APRN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2019
-----------------------------------------------------
Last Update Date | 08/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35600 HWY 27
-----------------------------------------------------
City | HAINES CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33844-3731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-866-9820
-----------------------------------------------------
Fax | 863-812-4455
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2380 NORTH BLVD W STE 1
-----------------------------------------------------
City | DAVENPORT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33837-8983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-422-8574
-----------------------------------------------------
Fax | 863-422-7251
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 11001484
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------