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General NPI Number Information
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NPI Number | 1750241121
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Entity Type | Individual
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Provider Name | JESSICA CHARLES
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Gender | Female
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Dates
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Enumeration Date | 11/17/2025
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Last Update Date | 11/17/2025
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Provider Practice Location Address
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Address Line | 8290 LAKE DR APT 432
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City | DORAL
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State | FL
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Zip | 33166-4632
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Country | US
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Telephone | 305-878-8971
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Fax | 305-878-8971
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Provider Business Mailing Address
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Address Line | 8290 LAKE DR APT 432
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City | DORAL
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State | FL
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Zip | 33166-4632
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11042437
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License Number State | FL
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