Healthcare Provider Details

I. General information

NPI: 1306564323
Provider Name (Legal Business Name): SALICONTE CHARLES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 W HILLSBORO BLVD
DEERFIELD BEACH FL
33442-1442
US

IV. Provider business mailing address

1827 W HILLSBORO BLVD
DEERFIELD BEACH FL
33442-1442
US

V. Phone/Fax

Practice location:
  • Phone: 954-800-4054
  • Fax:
Mailing address:
  • Phone: 954-800-4054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number11021404
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: