Healthcare Provider Details

I. General information

NPI: 1982153441
Provider Name (Legal Business Name): ELIZABETH ANNE CHARIF PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11190 HEALTH PARK BLVD
NAPLES FL
34110-5729
US

IV. Provider business mailing address

12189 COUNTRY DAY CIR
FORT MYERS FL
33913-7621
US

V. Phone/Fax

Practice location:
  • Phone: 407-461-1945
  • Fax:
Mailing address:
  • Phone: 407-461-1945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9109826
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: