Healthcare Provider Details

I. General information

NPI: 1194642165
Provider Name (Legal Business Name): JUNOU CHARLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 LEXINGTON RD
VERSAILLES KY
40383-1738
US

IV. Provider business mailing address

2020 NE 4TH PL
CAPE CORAL FL
33909-4349
US

V. Phone/Fax

Practice location:
  • Phone: 954-708-8352
  • Fax:
Mailing address:
  • Phone: 954-708-8352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9483998
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: