Individual
JACQUELINE CHARLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
234 ANSON DR, KISSIMMEE, FL 34758-4215
(407) 202-1184
Mailing address
234 ANSON DR, KISSIMMEE, FL 34758-4215
(407) 202-1184
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN 5218580
FL
Other
Enumeration date
11/10/2016
Last updated
11/10/2016
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