Healthcare Provider Details

I. General information

NPI: 1972796712
Provider Name (Legal Business Name): CHARISSE JEANINE HUOT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARISSE JEANINE RECORD MD

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 N MYRTLE AVE
CLEARWATER FL
33755-4254
US

IV. Provider business mailing address

807 N MYRTLE AVE
CLEARWATER FL
33755-4254
US

V. Phone/Fax

Practice location:
  • Phone: 727-467-2400
  • Fax: 727-467-2477
Mailing address:
  • Phone: 727-467-2400
  • Fax: 727-467-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME103984
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: