Provider Demographics
NPI:1659337814
Name:HERTEL, CHERI L (AP,MS,DIPLAC(NCCAOM))
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:L
Last Name:HERTEL
Suffix:
Gender:F
Credentials:AP,MS,DIPLAC(NCCAOM)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 OCEAN DUNES CIR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-9147
Mailing Address - Country:US
Mailing Address - Phone:561-694-8883
Mailing Address - Fax:
Practice Address - Street 1:108 INTRACOASTAL POINTE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-5036
Practice Address - Country:US
Practice Address - Phone:561-694-8883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1498171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCO810OtherBLUE CROSS/BLUE SHIELD