Individual
MRS. CHARLENE K MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
160 NW CENTRAL PARK PLZ STE 103, PORT ST LUCIE, FL 34986-1825
(772) 212-7636
(772) 212-7625
Mailing address
160 NW CENTRAL PARK PLZ STE 103, PORT ST LUCIE, FL 34986-1825
(772) 212-7636
(772) 212-7625
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
50002517
OH
363A00000X
Physician Assistant
Primary
PA9107673
FL
Other
Enumeration date
08/13/2008
Last updated
12/23/2022
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