Provider Demographics
NPI:1417241159
Name:KOCISKY, CHERYL LYNN (DNP ARNP-C)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:KOCISKY
Suffix:
Gender:F
Credentials:DNP ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 ROBIN RD S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-3827
Mailing Address - Country:US
Mailing Address - Phone:727-412-5214
Mailing Address - Fax:
Practice Address - Street 1:509 JACKSON ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1477
Practice Address - Country:US
Practice Address - Phone:727-820-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-29
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH-125774363LP2300X
FLARNP9363744363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care