Provider Demographics
NPI:1285728808
Name:DEMONBREUM, CYNTHIA RENEE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:RENEE
Last Name:DEMONBREUM
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 DAVID COLLINS DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-2813
Mailing Address - Country:US
Mailing Address - Phone:615-355-6175
Mailing Address - Fax:
Practice Address - Street 1:108 DAVID COLLINS DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-2813
Practice Address - Country:US
Practice Address - Phone:615-355-6175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005549363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily