Individual
DR. CHARLEEN L. ISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1120 PINELLAS BAYWAY, STE 200, TIERRA VERDE, FL 33715-1505
(727) 867-5480
(727) 867-5470
Mailing address
PO BOX 530968, ST PETERSBURG, FL 33747-0968
(727) 823-2188
(727) 828-0723
Taxonomy
Speciality
Code
Description
License number
State
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
ME0055512
FL
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
ME55512
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0100444
EVERCARE
—
01
—
09781
BCBS
FL
05
—
101276100
—
FL
01
—
267080
AVMED
—
01
—
4045500
AETNA
—
01
—
P00306082
RAILROAD MEDICARE
—
Enumeration date
08/22/2006
Last updated
02/13/2024
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