Provider Demographics
NPI:1194589192
Name:MACINTYRE, CYNTHIA DIANE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:DIANE
Last Name:MACINTYRE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1349 GILLICAN AVE NE
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:GA
Mailing Address - Zip Code:31331-8506
Mailing Address - Country:US
Mailing Address - Phone:912-269-0922
Mailing Address - Fax:
Practice Address - Street 1:106 SHOPPERS WAY
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-0530
Practice Address - Country:US
Practice Address - Phone:912-275-8028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN170046363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily