Provider Demographics
NPI:1023338076
Name:BOYETTE, CHERYL S (CRNA)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:S
Last Name:BOYETTE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:CHERYL
Other - Middle Name:S
Other - Last Name:CRADDOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:804 SCOTT NIXON MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2464
Mailing Address - Country:US
Mailing Address - Phone:800-394-4445
Mailing Address - Fax:706-650-1034
Practice Address - Street 1:92 W MILLER ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2032
Practice Address - Country:US
Practice Address - Phone:321-841-4607
Practice Address - Fax:321-841-4603
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLANT2564742367500000X
FLAPRN2564742367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered