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General NPI Number Information
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NPI Number | 1609768597
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Entity Type | Individual
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Provider Name | CHERYL ANN TYRE
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Gender | Female
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Dates
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Enumeration Date | 07/16/2025
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 1930 SE PORT ST LUCIE BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34952-5509
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Country | US
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Telephone | 772-335-3184
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Fax | 772-335-4256
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Provider Business Mailing Address
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Address Line | 11301 SW LYRA DR
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City | PORT ST LUCIE
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State | FL
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Zip | 34987-6420
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Country | US
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Telephone | 772-418-9963
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Fax |
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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 | 11041012
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License Number State | FL
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