Provider Demographics
NPI:1982624557
Name:BIDWELL, CYNTHIA R (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:R
Last Name:BIDWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14690 SPRING HILL DR
Mailing Address - Street 2:STE 305
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-277-5348
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:2323 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8818
Practice Address - Country:US
Practice Address - Phone:727-327-5188
Practice Address - Fax:727-321-3728
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102406363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0Q3ZOtherBCBS
FLIB643YMedicare PIN
FLY0Q3ZOtherBCBS
FLIB643XMedicare PIN