Provider Demographics
NPI:1730570136
Name:CINTRON-CUBERO, IVETTE DIANELLE (FNP-C)
Entity type:Individual
Prefix:
First Name:IVETTE
Middle Name:DIANELLE
Last Name:CINTRON-CUBERO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601843
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1035 DALE EARNHARDT BLVD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-4477
Practice Address - Country:US
Practice Address - Phone:704-316-1886
Practice Address - Fax:704-316-1887
Is Sole Proprietor?:No
Enumeration Date:2015-02-07
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007472363L00000X
NC188729363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1730570136Medicaid
SCNP3161Medicaid
NCNCN561EMedicare PIN
NCNCN561DMedicare PIN
NCNCN561BMedicare PIN
SCNP3161Medicaid
NC1730570136Medicaid