Provider Demographics
NPI:1295725562
Name:WADDELL, CYNTHIA R (ARNP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:R
Last Name:WADDELL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 COMMODITY CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9001
Mailing Address - Country:US
Mailing Address - Phone:407-423-1039
Mailing Address - Fax:407-425-2347
Practice Address - Street 1:8500 COMMODITY CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9001
Practice Address - Country:US
Practice Address - Phone:407-423-1039
Practice Address - Fax:407-425-2347
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9165885363LA2200X
FLARNP9165885363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9165885OtherMEDICAL LICENSE
FL014704300Medicaid
FLU0748WMedicare PIN