Healthcare Provider Details

I. General information

NPI: 1700713260
Provider Name (Legal Business Name): JANACE CHARLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5636 JOHNSON ST # 1119
HOLLYWOOD FL
33021-5632
US

IV. Provider business mailing address

5636 JOHNSON ST # 1119
HOLLYWOOD FL
33021-5632
US

V. Phone/Fax

Practice location:
  • Phone: 786-348-9739
  • Fax:
Mailing address:
  • Phone: 786-348-9739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: