Provider Demographics
NPI:1891010047
Name:ADAMS, CYNTHIA GAYLE (NP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:GAYLE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:NP
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 611584
Mailing Address - Street 2:
Mailing Address - City:ROSEMARY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32461-1007
Mailing Address - Country:US
Mailing Address - Phone:985-630-3445
Mailing Address - Fax:
Practice Address - Street 1:171 ROUND RD
Practice Address - Street 2:#611584
Practice Address - City:ROSEMARY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32461-1007
Practice Address - Country:US
Practice Address - Phone:985-630-3445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP02132363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP02132/RN0765868OtherLICENSE
LAPA021073OtherPA#
LA363L00000XOtherTAXONOMY NPI
LA0215890OtherANCC
LA1891010047OtherNPI
FLARNP 9361399, 173841OtherAPRN LICENSE
LA1686557Medicaid
LA3B684OtherMEDICARE FI/MAC: PINNACLE BUSINESS SOLUTIONS, INC.-LA