Healthcare Provider Details

I. General information

NPI: 1437679628
Provider Name (Legal Business Name): CHARLES LEE CHABOUDE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 MILITARY TRL STE 109
JUPITER FL
33458-7040
US

IV. Provider business mailing address

1025 MILITARY TRL STE 109
JUPITER FL
33458-7040
US

V. Phone/Fax

Practice location:
  • Phone: 561-659-6336
  • Fax: 561-659-9353
Mailing address:
  • Phone: 561-659-6336
  • Fax: 561-659-9353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number685906
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9488093
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number308731
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: