Healthcare Provider Details

I. General information

NPI: 1194267625
Provider Name (Legal Business Name): CRAIG A CHERRIN ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 BELFORT RD STE 1100
JACKSONVILLE FL
32216-5876
US

IV. Provider business mailing address

11945 SAN JOSE BLVD SUITE 300
JACKSONVILLE FL
32223-1613
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-3103
  • Fax: 904-296-3106
Mailing address:
  • Phone: 904-396-1725
  • Fax: 904-399-1717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9368162
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9368162
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: