Provider Demographics
NPI:1801829668
Name:ODOM-BROWN, CYNTHIA L (CRNA)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:L
Last Name:ODOM-BROWN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5955 JAEGERGLEN DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-5864
Mailing Address - Country:US
Mailing Address - Phone:813-315-9258
Mailing Address - Fax:479-587-0484
Practice Address - Street 1:5955 JAEGERGLEN DR
Practice Address - Street 2:SUITE 1
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-5864
Practice Address - Country:US
Practice Address - Phone:813-315-9258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9275981367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150134701Medicaid
AR5X383Medicare ID - Type Unspecified