Provider Demographics
NPI:1114996337
Name:CARSON, CYNTHIA A (CRNA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:CARSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 AVENUE OF OAKS
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29920-3636
Mailing Address - Country:US
Mailing Address - Phone:843-838-4456
Mailing Address - Fax:843-838-4456
Practice Address - Street 1:68 AVENUE OF OAKS
Practice Address - Street 2:
Practice Address - City:SAINT HELENA ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29920-3636
Practice Address - Country:US
Practice Address - Phone:843-838-4456
Practice Address - Fax:843-838-4456
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1218367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0637Medicaid
SCQ312477468Medicare PIN