Healthcare Provider Details

I. General information

NPI: 1184807547
Provider Name (Legal Business Name): CHERYL MORGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2007
Last Update Date: 12/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

482 SW TODD AVE
PORT ST LUCIE FL
34983-2914
US

IV. Provider business mailing address

482 SW TODD AVE
PORT ST LUCIE FL
34983-2914
US

V. Phone/Fax

Practice location:
  • Phone: 772-905-8047
  • Fax: 772-905-8047
Mailing address:
  • Phone: 772-905-8047
  • Fax: 772-905-8047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: