Provider Demographics
NPI:1508139312
Name:ABRAHAM, CYNTHIA ST CLAIR (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:ST CLAIR
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:ST CLAIR
Other - Last Name:ARCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:2718 LEE BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-1537
Mailing Address - Country:US
Mailing Address - Phone:239-303-9298
Mailing Address - Fax:239-694-9101
Practice Address - Street 1:2718 LEE BLVD
Practice Address - Street 2:STE B
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1537
Practice Address - Country:US
Practice Address - Phone:239-303-9298
Practice Address - Fax:239-694-9101
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2601442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1508139312Medicaid