Provider Demographics
NPI:1063481992
Name:SHORTLE, CYNTHIA LOU (NP)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LOU
Last Name:SHORTLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 W CRAIG PL APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3443
Mailing Address - Country:US
Mailing Address - Phone:210-849-5825
Mailing Address - Fax:
Practice Address - Street 1:519 W CRAIG PL APT 1
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3443
Practice Address - Country:US
Practice Address - Phone:210-849-5825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX573609363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q28955Medicare UPIN
8C8695Medicare ID - Type Unspecified