Provider Demographics
NPI:1699014621
Name:FOX, CHERYL A (CRNA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:FOX
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:A
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1613 HARRISON PKWY
Mailing Address - Street 2:SUITE 200, BLDG C
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2896
Mailing Address - Country:US
Mailing Address - Phone:954-838-2588
Mailing Address - Fax:954-514-3979
Practice Address - Street 1:2300 OPITZ BLVD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3311
Practice Address - Country:US
Practice Address - Phone:954-838-2588
Practice Address - Fax:954-514-3979
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001214635367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered