Provider Demographics
NPI:1255798013
Name:BROOKS, CYNTHIA SHARETTE (CNA)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SHARETTE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33870 BLUE STAR HWY APT 706
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:FL
Mailing Address - Zip Code:32343-2433
Mailing Address - Country:US
Mailing Address - Phone:904-517-9713
Mailing Address - Fax:
Practice Address - Street 1:33870 BLUE STAR HWY APT 706
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:FL
Practice Address - Zip Code:32343-2433
Practice Address - Country:US
Practice Address - Phone:904-517-9713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA185647376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide