=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942862206
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CINDY S WRIGHT DO PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2019
-----------------------------------------------------
Last Update Date | 07/07/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12627 SAN JOSE BLVD STE 902
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32223-8645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-877-0359
-----------------------------------------------------
Fax | 904-862-6767
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12627 SAN JOSE BLVD STE 902
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32223-8645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-877-0359
-----------------------------------------------------
Fax | 904-862-6767
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CINDY S WRIGHT
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 904-877-0359
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------