Provider Demographics
NPI:1831588185
Name:HEYNE, CYNTHIA (ARNP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:HEYNE
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 1:720 E NEW HAVEN AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5474
Mailing Address - Country:US
Mailing Address - Phone:321-724-4545
Mailing Address - Fax:321-728-4168
Practice Address - Street 1:720 E NEW HAVEN AVE STE 11
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5474
Practice Address - Country:US
Practice Address - Phone:321-724-4545
Practice Address - Fax:321-728-4168
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF1214474363LF0000X
FL2931202363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110934300Medicaid
FL$$$$$$$$$Medicaid
FL$$$$$$$$$Medicare UPIN