Provider Demographics
NPI:1194499038
Name:SMART, CHERIESE (RN)
Entity type:Individual
Prefix:
First Name:CHERIESE
Middle Name:
Last Name:SMART
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12756 LEMON PEPPER DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-7583
Mailing Address - Country:US
Mailing Address - Phone:347-512-8854
Mailing Address - Fax:
Practice Address - Street 1:12756 LEMON PEPPER DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-7583
Practice Address - Country:US
Practice Address - Phone:347-512-8854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9473511163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse