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General NPI Number Information
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NPI Number | 1205467677
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Entity Type | Individual
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Provider Name | MARIAH CHEEVERS APRN
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Gender | Female
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Dates
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Enumeration Date | 02/03/2020
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 4784 W US HIGHWAY 90
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City | LAKE CITY
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State | FL
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Zip | 32055-3101
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Country | US
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Telephone | 386-269-9260
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Fax | 386-406-6714
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Provider Business Mailing Address
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Address Line | 23476 NW 186TH AVE
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City | HIGH SPRINGS
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State | FL
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Zip | 32643-0673
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Country | US
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Telephone | 386-454-0698
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Fax | 386-454-0690
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11017424
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9411135
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License Number State | FL
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