Provider Demographics
NPI:1265215305
Name:JEANTINORD, CHERLY
Entity type:Individual
Prefix:MRS
First Name:CHERLY
Middle Name:
Last Name:JEANTINORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12957 SW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3818
Mailing Address - Country:US
Mailing Address - Phone:954-706-7606
Mailing Address - Fax:
Practice Address - Street 1:1190 NW 95TH ST STE 207
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2064
Practice Address - Country:US
Practice Address - Phone:305-835-7045
Practice Address - Fax:305-836-2359
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174226363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care