Provider Demographics
NPI:1326358144
Name:CHEREMOND, NICOLE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CHEREMOND
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 MEDICAL PARK DR
Mailing Address - Street 2:STE 510
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-6602
Mailing Address - Country:US
Mailing Address - Phone:813-872-4492
Mailing Address - Fax:
Practice Address - Street 1:3000 MEDICAL PARK DR STE 510
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-6602
Practice Address - Country:US
Practice Address - Phone:813-872-4492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9372961363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily