Provider Demographics
NPI:1225223845
Name:WARE-STARK, CHERAIL WINETT (LPN)
Entity type:Individual
Prefix:
First Name:CHERAIL
Middle Name:WINETT
Last Name:WARE-STARK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5514 DELIGHT DR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-5469
Mailing Address - Country:US
Mailing Address - Phone:413-333-1359
Mailing Address - Fax:
Practice Address - Street 1:5514 DELIGHT DR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-5469
Practice Address - Country:US
Practice Address - Phone:413-333-1359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2023-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 105912376K00000X
FL5204170164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's Aide