Provider Demographics
NPI:1598433435
Name:LETTERMAN, CYNTHIA HAILEY (RN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:HAILEY
Last Name:LETTERMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 INDIGO AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-5214
Mailing Address - Country:US
Mailing Address - Phone:904-343-1249
Mailing Address - Fax:
Practice Address - Street 1:2324 INDIGO AVE
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-5214
Practice Address - Country:US
Practice Address - Phone:904-343-1249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-04
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2997932163WC0200X, 163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN2997392OtherNURSE LISCENCE