Individual
CHARRELL THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
800 PRUDENTIAL DR, JACKSONVILLE, FL 32207-8202
(904) 202-1784
Mailing address
9968 WATERMARK LN W, JACKSONVILLE, FL 32256-4104
(904) 314-5256
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
ME80036
FL
207VG0400X
Gynecology Physician
ME80036
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
258985100
—
FL
Enumeration date
02/01/2007
Last updated
06/05/2024
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