Provider Demographics
NPI:1225199367
Name:DAFFAN, CYNTHIA SMITH (CRNP)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:SMITH
Last Name:DAFFAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11543 GUNNER CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5745
Mailing Address - Country:US
Mailing Address - Phone:703-590-9700
Mailing Address - Fax:
Practice Address - Street 1:337 MAPLE AVE E
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4717
Practice Address - Country:US
Practice Address - Phone:703-328-2188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001052767363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P12069Medicare UPIN
004150K32Medicare ID - Type Unspecified