Provider Demographics
NPI:1164198206
Name:KNOUSE, CHERYL JEAN
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:JEAN
Last Name:KNOUSE
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 1:227 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-2413
Mailing Address - Country:US
Mailing Address - Phone:407-436-5697
Mailing Address - Fax:
Practice Address - Street 1:227 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-2413
Practice Address - Country:US
Practice Address - Phone:407-436-5697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9202960163W00000X
FL11015669363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse