Healthcare Provider Details

I. General information

NPI: 1841569142
Provider Name (Legal Business Name): CHERYL KORDEK STANLEY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERYL DIANNE KORDEK ARNP

II. Dates (important events)

Enumeration Date: 12/16/2011
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 PASADENA AVE S SUITE 3M
SOUTH PASADENA FL
33707-4565
US

IV. Provider business mailing address

1609 PASADENA AVE S SUITE 3M
SOUTH PASADENA FL
33707-4565
US

V. Phone/Fax

Practice location:
  • Phone: 727-384-2016
  • Fax:
Mailing address:
  • Phone: 727-384-2016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9235090
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: