Healthcare Provider Details

I. General information

NPI: 1023338076
Provider Name (Legal Business Name): CHERYL S BOYETTE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS CHERYL S CRADDOCK

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 W DR MARTIN LUTHER KING JR BLVD STE 310
TAMPA FL
33607-6383
US

IV. Provider business mailing address

1344 MARION DR S
SAINT PETERSBURG FL
33707-3841
US

V. Phone/Fax

Practice location:
  • Phone: 813-350-7244
  • Fax: 813-350-7246
Mailing address:
  • Phone: 727-946-6495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN2564742
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: