Provider Demographics
NPI:1235387861
Name:CENKNER, DEANNALYNN
Entity Type:Individual
Prefix:
First Name:DEANNALYNN
Middle Name:
Last Name:CENKNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1438 GOYER RD SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-7629
Mailing Address - Country:US
Mailing Address - Phone:321-951-3766
Mailing Address - Fax:
Practice Address - Street 1:1438 GOYER RD SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-7629
Practice Address - Country:US
Practice Address - Phone:321-951-3766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL681118396172V00000X
FL681118398172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker