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General NPI Number Information
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NPI Number | 1033052451
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Entity Type | Individual
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Provider Name | JOSEPH CHARLES
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Gender | Male
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Dates
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Enumeration Date | 04/10/2026
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Last Update Date | 04/10/2026
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Provider Practice Location Address
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Address Line | 1014 MANDALAY DR
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City | BRANDON
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State | FL
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Zip | 33511-6732
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Country | US
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Telephone | 656-203-8587
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Fax |
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Provider Business Mailing Address
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Address Line | 1014 MANDALAY DR
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City | BRANDON
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State | FL
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Zip | 33511-6732
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Country | US
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Telephone | 656-203-8587
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State | FL
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