Provider Demographics
NPI:1336754084
Name:CYRUS, JADE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:CYRUS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:
Other - Last Name:CYRUS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JADE CYRUS, FNP
Mailing Address - Street 1:142 JOHN F KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1159
Mailing Address - Country:US
Mailing Address - Phone:904-334-0910
Mailing Address - Fax:
Practice Address - Street 1:142 JOHN F KENNEDY DR
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1159
Practice Address - Country:US
Practice Address - Phone:904-334-0910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008586363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily