Provider Demographics
NPI:1033785118
Name:WOOD, CYNTHIA KAY (FNP-C)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:KAY
Last Name:WOOD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 N 12TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-4250
Mailing Address - Country:US
Mailing Address - Phone:602-753-2345
Mailing Address - Fax:602-419-3062
Practice Address - Street 1:4520 N 12TH ST STE 103
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-4250
Practice Address - Country:US
Practice Address - Phone:602-753-2345
Practice Address - Fax:602-419-3062
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-31
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ257487363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily