Provider Demographics
NPI:1225392806
Name:DOUGLAS, CYNTHIA P (CFM)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:P
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 MAHAN CENTER BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-7404
Mailing Address - Country:US
Mailing Address - Phone:850-386-9447
Mailing Address - Fax:
Practice Address - Street 1:1641 MAHAN CENTER BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-7404
Practice Address - Country:US
Practice Address - Phone:850-386-9447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCFM02761224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter