Healthcare Provider Details

I. General information

NPI: 1598949877
Provider Name (Legal Business Name): CHARLENE Q OKONSKI DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2007
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 SCOTT ST UNIT 216
PUNTA GORDA FL
33950-3901
US

IV. Provider business mailing address

6210 SCOTT ST UNIT 216
PUNTA GORDA FL
33950-3901
US

V. Phone/Fax

Practice location:
  • Phone: 941-205-2666
  • Fax: 941-205-2665
Mailing address:
  • Phone: 941-205-2666
  • Fax: 941-205-2665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberOS7415
License Number StateFL

VIII. Authorized Official

Name: DR. CHARLENE Q OKOMSKI
Title or Position: PRESIDENT
Credential: D.O.
Phone: 941-205-2666