Provider Demographics
NPI:1639577661
Name:DEVINE, CYNTHIA S (APRN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:S
Last Name:DEVINE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:S
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4478
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34948
Mailing Address - Country:US
Mailing Address - Phone:302-678-8447
Mailing Address - Fax:772-252-4879
Practice Address - Street 1:310 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1078
Practice Address - Country:US
Practice Address - Phone:302-678-8447
Practice Address - Fax:772-252-4879
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEAPN-0001802363L00000X
FLAPRN11004113363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEAPN-0001802OtherSTATE LICENSE