Provider Demographics
NPI:1194234708
Name:MATCHETT, CHERYL RENEE
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:RENEE
Last Name:MATCHETT
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 1:831 MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-6356
Mailing Address - Country:US
Mailing Address - Phone:407-421-6505
Mailing Address - Fax:407-628-4943
Practice Address - Street 1:831 MAPLE CT
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-6356
Practice Address - Country:US
Practice Address - Phone:407-421-6505
Practice Address - Fax:407-421-6505
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233855372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL233855OtherAHCA LICENSE