Provider Demographics
NPI:1740628502
Name:DANIELS, CYNTHIA N (NP-C)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:N
Last Name:DANIELS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 NE BIG BEND TRL
Mailing Address - Street 2:
Mailing Address - City:GLEN ROSE
Mailing Address - State:TX
Mailing Address - Zip Code:76043-4942
Mailing Address - Country:US
Mailing Address - Phone:254-898-8499
Mailing Address - Fax:254-898-8506
Practice Address - Street 1:1009 NE BIG BEND TRL
Practice Address - Street 2:
Practice Address - City:GLEN ROSE
Practice Address - State:TX
Practice Address - Zip Code:76043-4942
Practice Address - Country:US
Practice Address - Phone:254-898-8499
Practice Address - Fax:254-898-8506
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX727246363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX330293702Medicaid