Provider Demographics
NPI:1639294622
Name:CINTRON, SUSAN B (AARNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:B
Last Name:CINTRON
Suffix:
Gender:F
Credentials:AARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2814
Mailing Address - Country:US
Mailing Address - Phone:813-657-9198
Mailing Address - Fax:
Practice Address - Street 1:611 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-2814
Practice Address - Country:US
Practice Address - Phone:813-657-9198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1777802363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766539300Medicaid