Provider Demographics
NPI:1043779713
Name:HART, CHERYL DIANE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:DIANE
Last Name:HART
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:DIANE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 OAKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5700
Mailing Address - Country:US
Mailing Address - Phone:813-684-2229
Mailing Address - Fax:813-813-0330
Practice Address - Street 1:505 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5700
Practice Address - Country:US
Practice Address - Phone:813-684-2229
Practice Address - Fax:813-813-0330
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9482974363L00000X, 363LF0000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily