Provider Demographics
NPI:1508280710
Name:MARK, CHERILYN (FNP)
Entity Type:Individual
Prefix:
First Name:CHERILYN
Middle Name:
Last Name:MARK
Suffix:
Gender:F
Credentials:FNP
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 542
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95061-0542
Mailing Address - Country:US
Mailing Address - Phone:831-427-3500
Mailing Address - Fax:
Practice Address - Street 1:1510 CAPITOLA RD
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2912
Practice Address - Country:US
Practice Address - Phone:831-427-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95042257163W00000X
NY672574163W00000X
NY339454363LF0000X
CA95006134363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse