Provider Demographics
NPI:1083506109
Name:BREAK THE ST;GMA, PLLC
Entity type:Organization
Organization Name:BREAK THE ST;GMA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO FOUNDER, PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:CYNOWA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC, FNP-BC
Authorized Official - Phone:910-494-4017
Mailing Address - Street 1:304 BARCELONA DR APT 13A
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5752
Mailing Address - Country:US
Mailing Address - Phone:910-494-4017
Mailing Address - Fax:984-304-8331
Practice Address - Street 1:304 BARCELONA DR APT 13A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5752
Practice Address - Country:US
Practice Address - Phone:910-494-4017
Practice Address - Fax:984-304-8331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-15
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty