Provider Demographics
NPI:1760096945
Name:CYNTJE, HERMINA
Entity Type:Individual
Prefix:MRS
First Name:HERMINA
Middle Name:
Last Name:CYNTJE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13060 WATERBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONTON
Mailing Address - State:FL
Mailing Address - Zip Code:33534-3908
Mailing Address - Country:US
Mailing Address - Phone:813-380-6213
Mailing Address - Fax:
Practice Address - Street 1:13060 WATERBOURNE DR
Practice Address - Street 2:
Practice Address - City:GIBSONTON
Practice Address - State:FL
Practice Address - Zip Code:33534-3908
Practice Address - Country:US
Practice Address - Phone:813-380-6213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL190002349823747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL19000234982OtherHOME HEALTH CARE
FLL19000234982OtherHOME HEATH CARE
L19000234982OtherHOME CARE