Healthcare Provider Details

I. General information

NPI: 1659226397
Provider Name (Legal Business Name): SHERLIE CHARLOT ADVANCED PRACTICE RE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 WOODFIELD CT
GREENACRES FL
33415-1409
US

IV. Provider business mailing address

1121 WOODFIELD CT
GREENACRES FL
33415-1409
US

V. Phone/Fax

Practice location:
  • Phone: 561-568-3612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11050921
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: