Healthcare Provider Details

I. General information

NPI: 1356707657
Provider Name (Legal Business Name): MRS. CHERYL ANN CONLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERYL ANN DOSADO NP-C

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 HIGHLAND PARK BLVD SUITE A
LAKELAND FL
33813-1639
US

IV. Provider business mailing address

4315 HIGHLAND PARK BLVD SUITE A
LAKELAND FL
33813-1639
US

V. Phone/Fax

Practice location:
  • Phone: 863-816-5884
  • Fax: 863-698-7962
Mailing address:
  • Phone: 863-816-5884
  • Fax: 863-698-7962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9199037
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: