Healthcare Provider Details

I. General information

NPI: 1205467677
Provider Name (Legal Business Name): MARIAH CHEEVERS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARIAH BOWEN APRN

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4784 W US HIGHWAY 90
LAKE CITY FL
32055-3101
US

IV. Provider business mailing address

23476 NW 186TH AVE
HIGH SPRINGS FL
32643-0673
US

V. Phone/Fax

Practice location:
  • Phone: 386-269-9260
  • Fax: 386-406-6714
Mailing address:
  • Phone: 386-454-0698
  • Fax: 386-454-0690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11017424
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9411135
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: