Provider Demographics
NPI:1679532543
Name:CRADDOCK, CHERYLL DENISE (LPN)
Entity Type:Individual
Prefix:
First Name:CHERYLL
Middle Name:DENISE
Last Name:CRADDOCK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 EASTLAKE CLUB DR
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-2470
Mailing Address - Country:US
Mailing Address - Phone:727-784-1649
Mailing Address - Fax:727-781-8285
Practice Address - Street 1:715 EASTLAKE CLUB DR
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-2470
Practice Address - Country:US
Practice Address - Phone:727-784-1649
Practice Address - Fax:727-781-8285
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5158790164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse