Provider Demographics
NPI:1316654262
Name:THOMAS, CHEETARA (CPT,CNA)
Entity type:Individual
Prefix:
First Name:CHEETARA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CPT,CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13616 ASHLAR SLATE PL
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-2139
Mailing Address - Country:US
Mailing Address - Phone:863-201-0782
Mailing Address - Fax:
Practice Address - Street 1:13616 ASHLAR SLATE PL
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-2139
Practice Address - Country:US
Practice Address - Phone:863-201-0782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X, 374700000X, 374U00000X, 376J00000X
FLCNA356548376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372600000XNursing Service Related ProvidersAdult Companion
No374700000XNursing Service Related ProvidersTechnician
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker