Provider Demographics
NPI:1619612645
Name:HERMOSILLO, CYNTHIA JOANN (FNP-C, APRN)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:JOANN
Last Name:HERMOSILLO
Suffix:
Gender:F
Credentials:FNP-C, APRN
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:JOANN
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP, APRN
Mailing Address - Street 1:1124 E SAN CARLOS WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-4712
Mailing Address - Country:US
Mailing Address - Phone:480-299-3761
Mailing Address - Fax:
Practice Address - Street 1:3744 S ROME ST
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7350
Practice Address - Country:US
Practice Address - Phone:480-224-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN217169163W00000X
AZ279889363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse