Provider Demographics
NPI:1326062183
Name:WRIGHT, CINDY S (DO)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:S
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12627 SAN JOSE BLVD
Mailing Address - Street 2:STE 902
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8645
Mailing Address - Country:US
Mailing Address - Phone:843-450-5202
Mailing Address - Fax:904-647-5455
Practice Address - Street 1:12627 SAN JOSE BLVD
Practice Address - Street 2:STE 902
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8645
Practice Address - Country:US
Practice Address - Phone:843-450-5202
Practice Address - Fax:843-450-5202
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0553207Q00000X
ALDO445207Q00000X
OK3398207Q00000X
FLOS12723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT00736Medicaid
FL013957100Medicaid
SCT00736Medicaid