Individual
JODEA A CHARLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3301 W GANDY BLVD, TAMPA, FL 33611-2931
(813) 925-1903
(813) 749-8370
Mailing address
10221 SUMMER KISS AVE, RIVERVIEW, FL 33578-5851
(239) 464-2147
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9116716
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116111200
—
FL
01
—
1200545
PA-C
FL
Enumeration date
09/19/2022
Last updated
12/09/2024
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