Provider Demographics
NPI:1407428667
Name:ZWICK, CYENTHIA LAVONE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CYENTHIA
Middle Name:LAVONE
Last Name:ZWICK
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 COACH LEE HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-2182
Mailing Address - Country:US
Mailing Address - Phone:912-662-6501
Mailing Address - Fax:912-681-1012
Practice Address - Street 1:19 LESTER RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-2119
Practice Address - Country:US
Practice Address - Phone:912-662-6501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9433970163W00000X
GARN107169163W00000X, 363LP0808X
FL11014238363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse