Provider Demographics
NPI:1902835473
Name:JENSEN, CYNTHIA A (ACNP)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:A
Last Name:JENSEN
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 HOSPITAL ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5329
Mailing Address - Country:US
Mailing Address - Phone:228-762-1002
Mailing Address - Fax:228-762-1012
Practice Address - Street 1:4300 HOSPITAL ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5329
Practice Address - Country:US
Practice Address - Phone:228-762-1002
Practice Address - Fax:228-762-1012
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR792936363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care