Provider Demographics
NPI:1023126497
Name:GAMBLE, CYNTHIA BETH (ARNP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:BETH
Last Name:GAMBLE
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 1:600 NOKOMIS AVE S STE 207
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-3209
Mailing Address - Country:US
Mailing Address - Phone:941-486-6790
Mailing Address - Fax:941-486-6795
Practice Address - Street 1:600 NOKOMIS AVE S STE 207
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-3209
Practice Address - Country:US
Practice Address - Phone:941-486-6790
Practice Address - Fax:941-486-6795
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9264960363LA2200X
WI3636-033363LA2200X
FLARNP9264960363L00000X
NC105507163W00000X
NC900407363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014634700Medicaid
SCNP0762Medicaid
NC7000981Medicaid
Q06131Medicare UPIN
SCNP0762Medicaid
NC7000981Medicaid
FLID033ZMedicare PIN