Provider Demographics
NPI:1629178983
Name:GAVILANES, CYNTHIA E (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:E
Last Name:GAVILANES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 COLONIAL BLVD.
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:603 N FLAMINGO RD STE 251
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1013
Practice Address - Country:US
Practice Address - Phone:954-430-3999
Practice Address - Fax:954-430-8999
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9103698363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7203919OtherAETNA
FL8313297OtherCIGNA
FLYRSCVOtherBCBS
FL406717OtherAVMED
FLQMP000005335032OtherMOLINA HEALTHCARE
FL404CBOtherBCBS