Healthcare Provider Details

I. General information

NPI: 1710574868
Provider Name (Legal Business Name): ORLYNE CHARLES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ORLYNE FELIX

II. Dates (important events)

Enumeration Date: 12/23/2020
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 GOLFVIEW AVE
BARTOW FL
33830-6736
US

IV. Provider business mailing address

PO BOX 1559
BARTOW FL
33831-1559
US

V. Phone/Fax

Practice location:
  • Phone: 863-519-0575
  • Fax:
Mailing address:
  • Phone: 863-519-0575
  • Fax: 863-582-9251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9275864
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11018709
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: