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General NPI Number Information
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NPI Number | 1053427716
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Entity Type | Individual
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Provider Name | CHARLEEN L. ISE MD
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Gender | Female
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 1120 PINELLAS BAYWAY STE 200
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City | TIERRA VERDE
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State | FL
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Zip | 33715-1505
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Country | US
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Telephone | 727-867-5480
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Fax | 727-867-5470
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Provider Business Mailing Address
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Address Line | PO BOX 530968
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City | ST PETERSBURG
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State | FL
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Zip | 33747-0968
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Country | US
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Telephone | 727-823-2188
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Fax | 727-828-0723
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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 | 207PE0005X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
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License Number | ME0055512
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number | ME55512
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License Number State | FL
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