Provider Demographics
NPI:1114379815
Name:CERVELLERA, CHELSEA
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:CERVELLERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 SE 18TH ST
Mailing Address - Street 2:STE 1202
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5454
Mailing Address - Country:US
Mailing Address - Phone:352-233-2360
Mailing Address - Fax:352-233-2363
Practice Address - Street 1:1740 SE 18TH ST STE 1202
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-732-8630
Practice Address - Fax:352-867-7895
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9361650363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner