Healthcare Provider Details

I. General information

NPI: 1245954288
Provider Name (Legal Business Name): CHERYL ANN PITOCK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 COMMERCE RD
HOLLAND OH
43528-8689
US

IV. Provider business mailing address

6864 GETTYSBURG DR
SYLVANIA OH
43560-3291
US

V. Phone/Fax

Practice location:
  • Phone: 567-408-5377
  • Fax: 419-273-0509
Mailing address:
  • Phone: 734-625-1032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRNCNP00039350
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704368515NSA220F6
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: