Individual provider Active NPI

Cheryl Smith O'Donoghue, FNP-BC

  • Family Nurse Practitioner
  • Fernandina Beach, FL
National Provider Identifier
1194081521
Registry record updated Jan 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN062128 Issued in GA
Practice address
96279 Brady Point Rd.
Fernandina Beach, FL 32034
Phone
(912) 882-6767
Fax
(912) 882-6411
NPI assigned
Apr 10, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN062128 GA Primary

Addresses

Primary practice location

96279 Brady Point Rd.
Fernandina Beach, FL 32034

Mailing address

96279 Brady Point Rd.
Fernandina Beach, FL 32034
Phone (904) 321-0088

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120614000435 GA Practitioner - Nurse Practitioner 6507020955 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
RN062128GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cooperative Healthcare Services Inc CurrentSince May 1, 2012 Accepting new patients

Locations

2415 Parkwood Dr
Brunswick, GA 31520
Phone (912) 466-4079

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1334016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484092800000",
    "number": "1194081521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "96279 BRADY POINT RD.",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "32034",
            "telephone_number": "904-321-0088",
            "fax_number": "912-882-6411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96279 BRADY POINT RD.",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "32034",
            "telephone_number": "912-882-6767",
            "fax_number": "912-882-6411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'DONOGHUE",
        "first_name": "CHERYL",
        "middle_name": "SMITH",
        "name_prefix": "Ms.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-10",
        "last_updated": "2017-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN062128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fernandina Beach, FL

Sources for this page

Verify at the official NPI Registry.