Healthcare Provider Details

I. General information

NPI: 1003213547
Provider Name (Legal Business Name): SHERLEY CHARLES FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2014
Last Update Date: 10/24/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1272 NW 119TH ST
MIAMI FL
33167-3232
US

IV. Provider business mailing address

1272 NW 119TH ST
MIAMI FL
33167-3232
US

V. Phone/Fax

Practice location:
  • Phone: 305-685-5688
  • Fax:
Mailing address:
  • Phone: 305-685-5688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9265908
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: