Provider Demographics
NPI:1841831690
Name:AMBROISE, CYNTHIA (NP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:AMBROISE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 HAWTHORNE LN STE 110200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2484
Mailing Address - Country:US
Mailing Address - Phone:888-236-0631
Mailing Address - Fax:704-272-3231
Practice Address - Street 1:1630 OAKHURST COMMONS DR STE 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6382
Practice Address - Country:US
Practice Address - Phone:888-236-0631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012352363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care