Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | APRN11004214 | FL |
NPI | 1003457623 |
---|---|
Provider Name | Cheryl Renae Abersold |
First Address | Live Oak, FL 32060-6560 |
Second Address | Lake City, FL 32025-6966 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2019 |
Last Update Date | 04/10/2019 |