Provider Demographics
NPI:1710971221
Name:BROADNAX, CYNTHIA DENISE (MSN, CRNP)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:DENISE
Last Name:BROADNAX
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22389
Mailing Address - Street 2:PMB 82739
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37202-2389
Mailing Address - Country:US
Mailing Address - Phone:866-315-2626
Mailing Address - Fax:
Practice Address - Street 1:6660 SECURITY BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAWN
Practice Address - State:MD
Practice Address - Zip Code:21207-4012
Practice Address - Country:US
Practice Address - Phone:443-380-0552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR125951363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD082NL382Medicare UPIN
DC019239M72Medicare UPIN