Healthcare Provider Details

I. General information

NPI: 1225957624
Provider Name (Legal Business Name): NYEISHA COGDELL CNA, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

974 HEARTWOOD RD
GAINESVILLE FL
32641-0011
US

IV. Provider business mailing address

974 HEARTWOOD RD
GAINESVILLE FL
32641-0011
US

V. Phone/Fax

Practice location:
  • Phone: 352-327-1247
  • Fax:
Mailing address:
  • Phone: 352-327-1247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA440066
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: