Provider Demographics
NPI:1669423075
Name:HERNANDEZ, CYNTHIA I (CRNA)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:I
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:CYNTHIA
Other - Middle Name:I
Other - Last Name:THORNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3950 W MADURA RD
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-3562
Mailing Address - Country:US
Mailing Address - Phone:850-501-0540
Mailing Address - Fax:
Practice Address - Street 1:1000 W MORENO ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-2316
Practice Address - Country:US
Practice Address - Phone:850-437-8275
Practice Address - Fax:850-437-8394
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9212219367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG3460OtherBCBS
P00134583OtherPALMETTO GBA-RR MEDICARE
AL59173344OtherBCBS
AL009982315Medicaid
FL306781500Medicaid
AL59173345OtherBCBS
FL306781500Medicaid
P00134583OtherPALMETTO GBA-RR MEDICARE