Provider Demographics
NPI:1144532888
Name:CHARLES, MARIE JEANNETTE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:MARIE JEANNETTE
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9066 SW 73RD CT
Mailing Address - Street 2:UNIT 1508
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2969
Mailing Address - Country:US
Mailing Address - Phone:305-382-8457
Mailing Address - Fax:305-382-8457
Practice Address - Street 1:9066 SW 73RD CT
Practice Address - Street 2:UNIT 1508
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2969
Practice Address - Country:US
Practice Address - Phone:305-382-8457
Practice Address - Fax:305-382-8457
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL2100962363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL153825Medicaid
FL153825Medicare UPIN
FL153825Medicaid
FL1538252911Medicare NSC
FL153825Medicare Oscar/Certification