Provider Demographics
NPI:1912236738
Name:PARK, CYNTHIA ANNE (ACNP-BC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANNE
Last Name:PARK
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6925 HWY 74
Mailing Address - Street 2:
Mailing Address - City:ST GABRIEL
Mailing Address - State:LA
Mailing Address - Zip Code:70776
Mailing Address - Country:US
Mailing Address - Phone:225-319-4508
Mailing Address - Fax:225-319-4595
Practice Address - Street 1:6925 HIGHWAY 74
Practice Address - Street 2:
Practice Address - City:ST. GABRIEL
Practice Address - State:LA
Practice Address - Zip Code:70776
Practice Address - Country:US
Practice Address - Phone:225-319-4508
Practice Address - Fax:225-319-4595
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05157364SA2100X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health