MEDICARE: DR. CHERYL ANNE COCKRAM PHD.,ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1944112	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174577399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHERYL ANNE COCKRAM PHD.,ARNP

Provider Business Mailing Address
First Line	:	5009 PALOMA DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-4343
Country	:	US
Telephone Number	:	813-903-3615
Fax Number	:

Provider Business Practice Location Address
First Line	:	10770 N 46TH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-3442
Country	:	US
Telephone Number	:	813-903-3615
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	06/27/2012

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