MEDICARE: CYNTHIA AMBROISE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	5012352	NC
2	363L00000X	Nurse Practitioner	5012352	NC

General Provider Information

NPI Number	:	1841831690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA AMBROISE NP

Provider Business Mailing Address
First Line	:	401 HAWTHORNE LN STE 110200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2484
Country	:	US
Telephone Number	:	888-236-0631
Fax Number	:	704-272-3231

Provider Business Practice Location Address
First Line	:	1630 OAKHURST COMMONS DR STE 201
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6382
Country	:	US
Telephone Number	:	888-236-0631
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2019
Last Update Date	:	10/03/2022

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