Individual
MRS. EVENA JEAN CHARLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1551 DOZIER CIR SE, PALM BAY, FL 32909-6535
(321) 723-8383
Mailing address
1551 DOZIER CIR SE, PALM BAY, FL 32909-6535
(321) 723-8383
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6906630
—
FL
Enumeration date
05/09/2014
Last updated
05/09/2014
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