Healthcare Provider Details

I. General information

NPI: 1992838205
Provider Name (Legal Business Name): CHERYL A O'DONNELL PHD., ARNP, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19531 COCHRAN BLVD
PORT CHARLOTTE FL
33948-2081
US

IV. Provider business mailing address

3434 HANCOCK BRIDGE PKWY STE 301
N FORT MYERS FL
33903-7094
US

V. Phone/Fax

Practice location:
  • Phone: 941-255-3535
  • Fax: 941-766-7999
Mailing address:
  • Phone: 877-856-3774
  • Fax: 239-599-2625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2109902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: