Provider Demographics
NPI:1457849879
Name:DOUGLAS, CYNTHIA GODWIN (LPN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:GODWIN
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 BAYFRONT TER
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-5508
Mailing Address - Country:US
Mailing Address - Phone:772-589-6434
Mailing Address - Fax:
Practice Address - Street 1:356 BAYFRONT TER
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-5508
Practice Address - Country:US
Practice Address - Phone:772-589-6434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health