Healthcare Provider Details

I. General information

NPI: 1952730111
Provider Name (Legal Business Name): JEAN PHILIPPE CHARLES P.A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1648 NE 163RD ST
NORTH MIAMI BEACH FL
33162-4731
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 305-949-2000
  • Fax: 305-957-1166
Mailing address:
  • Phone: 305-500-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9107509
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: