Provider Demographics
NPI:1275547978
Name:TATE, CYNTHIA R (ANP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:R
Last Name:TATE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4316
Mailing Address - Country:US
Mailing Address - Phone:501-202-1902
Mailing Address - Fax:501-202-1512
Practice Address - Street 1:9500 KANIS RD
Practice Address - Street 2:HICKINGBOTHAM OUTPATIENT CENTER
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6324
Practice Address - Country:US
Practice Address - Phone:501-202-1902
Practice Address - Fax:501-202-1512
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01369363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
71-0781138OtherMULTIPLAN
AR152484758Medicaid
5U644OtherBCBS
71-0781138028OtherTRICARE
4235835OtherCIGNA
655627OtherHEALTHLINK
5U644OtherBCBS
71-0781138OtherMULTIPLAN
P00356930Medicare PIN