Provider Demographics
NPI:1346904729
Name:KESHAVARZ, CINDY LYNN (AGNP)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:LYNN
Last Name:KESHAVARZ
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2576 GRAMERCY DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-1940
Mailing Address - Country:US
Mailing Address - Phone:407-969-5090
Mailing Address - Fax:
Practice Address - Street 1:2576 GRAMERCY DR
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-1940
Practice Address - Country:US
Practice Address - Phone:407-969-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11015754363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health