Provider Demographics
NPI:1346653359
Name:WALLS, CHERIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:CHERIE
Middle Name:
Last Name:WALLS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 919741
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-9741
Mailing Address - Country:US
Mailing Address - Phone:321-841-3900
Mailing Address - Fax:321-843-6075
Practice Address - Street 1:17000 PORTER RD STE 201
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-8915
Practice Address - Country:US
Practice Address - Phone:407-635-3058
Practice Address - Fax:407-636-7826
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28175236A363LF0000X
IN71004944A363LF0000X
FLAPRN11020580363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily