Provider Demographics
NPI:1972990992
Name:HACKBART, CYNTHIA SHAWN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:SHAWN
Last Name:HACKBART
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3250 DURHAM PL
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-2934
Mailing Address - Country:US
Mailing Address - Phone:267-353-9824
Mailing Address - Fax:
Practice Address - Street 1:3185 ROUTE 27
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:NJ
Practice Address - Zip Code:08823
Practice Address - Country:US
Practice Address - Phone:732-422-4889
Practice Address - Fax:732-940-8724
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014756363LF0000X
NJ26NJ00727800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily