Provider Demographics
NPI:1356707657
Name:CONLEY, CHERYL ANN
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANN
Last Name:CONLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:DOSADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:4315 HIGHLAND PARK BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1639
Mailing Address - Country:US
Mailing Address - Phone:863-816-5884
Mailing Address - Fax:863-698-7962
Practice Address - Street 1:4315 HIGHLAND PARK BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1639
Practice Address - Country:US
Practice Address - Phone:863-816-5884
Practice Address - Fax:863-698-7962
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9199037363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily