Active NPI
Cynthia Lee Probasco, RN
- Medical-Surgical Registered Nurse
- Jacksonville, NC
National Provider Identifier
1033389457
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical-Surgical Registered Nurse
- License
- 195141
- Practice address
- 636 Maynard Blvd
Jacksonville, NC 28546-9106 - Phone
- (910) 347-7596
- Fax
- (910) 347-7596
- NPI assigned
- Mar 3, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical-Surgical Registered Nurse | 163WM0705X | 195141 | NC | Primary |
Addresses
Primary practice location
636 Maynard Blvd
Jacksonville, NC 28546-9106
Mailing address
636 Maynard Boulevard
Jacksonville, NC 28546
Phone (910) 347-7596
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 195141 | NC | MD | Medical-Surgical Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204502400000",
"number": "1033389457",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "636 MAYNARD BOULEVARD",
"city": "JACKSONVILLE",
"state": "NC",
"postal_code": "28546",
"telephone_number": "910-347-7596",
"fax_number": "910-347-7596"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "636 MAYNARD BLVD",
"city": "JACKSONVILLE",
"state": "NC",
"postal_code": "285469106",
"telephone_number": "910-347-7596",
"fax_number": "910-347-7596"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROBASCO",
"first_name": "CYNTHIA",
"middle_name": "LEE",
"name_prefix": "Mrs.",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-03",
"last_updated": "2008-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "163WM0705X",
"taxonomy_group": "",
"desc": "Registered Nurse, Medical-Surgical",
"state": "NC",
"license": "195141",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.