Provider Demographics
NPI:1326329921
Name:ROCHE, CHERYL KIM (APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:KIM
Last Name:ROCHE
Suffix:
Gender:F
Credentials:APRN, FNP-BC
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Other - Credentials:
Mailing Address - Street 1:PO BOX 45443
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84145-0443
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:1375 ROBERTS DR STE 204
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3209
Practice Address - Country:US
Practice Address - Phone:904-247-0056
Practice Address - Fax:904-241-0065
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN2948662363LF0000X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL116180700Medicaid