Provider Demographics
NPI:1861635781
Name:EBLEN, CYNTHIA A (APN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:EBLEN
Suffix:
Gender:F
Credentials:APN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320-1734
Mailing Address - Country:US
Mailing Address - Phone:731-584-1430
Mailing Address - Fax:731-584-1439
Practice Address - Street 1:30 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-1734
Practice Address - Country:US
Practice Address - Phone:731-584-1430
Practice Address - Fax:731-584-1439
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000013949363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3380640OtherGROUP MEDICAID
TN3380640OtherGROUP MEDICARE