Provider Demographics
NPI:1023752185
Name:DEVEAUX-MOONA, CYNTHIA YVONNE (FNP-BC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:YVONNE
Last Name:DEVEAUX-MOONA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:YVONNE
Other - Last Name:DEVEAUX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1301 N TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-2402
Mailing Address - Country:US
Mailing Address - Phone:941-366-7667
Mailing Address - Fax:941-953-5506
Practice Address - Street 1:1301 N TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-2402
Practice Address - Country:US
Practice Address - Phone:941-366-7667
Practice Address - Fax:941-953-5506
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11019281363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily