Provider Demographics
NPI:1881674901
Name:FEAGAN, CYNTHIA A (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:A
Last Name:FEAGAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14071 METROPOLIS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4330
Mailing Address - Country:US
Mailing Address - Phone:239-694-7546
Mailing Address - Fax:239-694-1571
Practice Address - Street 1:14071 METROPOLIS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4330
Practice Address - Country:US
Practice Address - Phone:239-694-7546
Practice Address - Fax:239-694-1571
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9388322363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100372280AMedicaid
500014478OtherRR MEDICARE
KS100372280AMedicaid
500014478OtherRR MEDICARE