Provider Demographics
NPI:1841569142
Name:STANLEY, CHERYL KORDEK (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:KORDEK
Last Name:STANLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:DIANNE
Other - Last Name:KORDEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:1609 PASADENA AVE S
Mailing Address - Street 2:SUITE 3M
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-4565
Mailing Address - Country:US
Mailing Address - Phone:727-384-2016
Mailing Address - Fax:
Practice Address - Street 1:1609 PASADENA AVE S
Practice Address - Street 2:SUITE 3M
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-4565
Practice Address - Country:US
Practice Address - Phone:727-384-2016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9235090363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGY799ZOtherPTAN