Healthcare Provider Details

I. General information

NPI: 1730498015
Provider Name (Legal Business Name): CHERYL GERTRUDE HOLDER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE ACC WEST ADMINISTRATION
MIAMI FL
33136-1005
US

IV. Provider business mailing address

3111 NW 190TH ST
MIAMI GARDENS FL
33056-3018
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6357
  • Fax:
Mailing address:
  • Phone: 305-621-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN 3411332
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 3411332
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: