Healthcare Provider Details

I. General information

NPI: 1376359679
Provider Name (Legal Business Name): ALEXANDRA JEAN CHARLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1089 S HIAWASSEE RD APT 323
ORLANDO FL
32835-1727
US

IV. Provider business mailing address

1089 S HIAWASSEE RD APT 323
ORLANDO FL
32835-1727
US

V. Phone/Fax

Practice location:
  • Phone: 857-264-7793
  • Fax:
Mailing address:
  • Phone: 617-834-3646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: