Provider Demographics
NPI:1902891252
Name:COHEN, CYNTHIA ANN (RN,FNP-C)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:COHEN
Suffix:
Gender:F
Credentials:RN,FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 W STEWART DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3854
Mailing Address - Country:US
Mailing Address - Phone:714-639-9401
Mailing Address - Fax:714-639-7095
Practice Address - Street 1:18102 IRVINE BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3402
Practice Address - Country:US
Practice Address - Phone:714-832-0510
Practice Address - Fax:714-832-2716
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA14684363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1912919804OtherTYPE 2 NPI
CA1720247455OtherTYPE 2 NPI
CADE828XMedicare PIN
CA1720247455OtherTYPE 2 NPI
CAW1514Medicare PIN
CADE828YMedicare PIN