Provider Demographics
NPI:1548022486
Name:POWELL, CHERYL (ACNPC-AG)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12212 DUSTY MILLER PL
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7721
Mailing Address - Country:US
Mailing Address - Phone:727-480-4811
Mailing Address - Fax:
Practice Address - Street 1:12212 DUSTY MILLER PL
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-7721
Practice Address - Country:US
Practice Address - Phone:727-480-4811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029768363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care