Individual
CHARLENE JARVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
405 FLORIDA AVE, COCOA, FL 32922-7929
(321) 961-3787
Mailing address
1087 MADRID RD, ROCKLEDGE, FL 32955-3325
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA#25858
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C-8874
BCBS
FL
Enumeration date
08/30/2006
Last updated
07/08/2007
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