Healthcare Provider Details

I. General information

NPI: 1407324700
Provider Name (Legal Business Name): CHEREZ POUNCEY NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 10/30/2026
Certification Date: 10/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 S BAY ST
EUSTIS FL
32726-4860
US

IV. Provider business mailing address

612 S BAY ST
EUSTIS FL
32726-4860
US

V. Phone/Fax

Practice location:
  • Phone: 352-492-1564
  • Fax:
Mailing address:
  • Phone: 850-544-9866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11000052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: