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General NPI Number Information
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NPI Number | 1558106898
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Entity Type | Individual
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Provider Name | CHARLOTTE EKSTROM
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Gender | Female
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Dates
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Enumeration Date | 06/27/2024
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 3630 MANATEE AVE W
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City | BRADENTON
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State | FL
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Zip | 34205-2557
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Country | US
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Telephone | 941-792-1881
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Fax | 941-795-3924
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Provider Business Mailing Address
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Address Line | PO BOX 102222
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City | ATLANTA
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State | GA
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Zip | 30368-2222
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Country | US
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Telephone | 239-274-8200
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11033664
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 11033664
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 11033664
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APRN11033664
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License Number State | FL
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