Provider Demographics
NPI:1194081521
Name:O'DONOGHUE, CHERYL SMITH (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:SMITH
Last Name:O'DONOGHUE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:96279 BRADY POINT RD.
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034
Mailing Address - Country:US
Mailing Address - Phone:904-321-0088
Mailing Address - Fax:912-882-6411
Practice Address - Street 1:96279 BRADY POINT RD.
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034
Practice Address - Country:US
Practice Address - Phone:912-882-6767
Practice Address - Fax:912-882-6411
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN062128363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily