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General NPI Number Information
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NPI Number | 1790826469
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Entity Type | Individual
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Provider Name | JENNIFER R CHARLES PAC
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Gender | Female
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 13400 SW 120TH ST SUITE 101 MIAMI CHILDREN'S HOSPITAL
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City | MIAMI
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State | FL
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Zip | 33186-7440
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Country | US
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Telephone | 305-278-5951
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Fax | 305-278-5971
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Provider Business Mailing Address
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Address Line | 13400 SW 120TH ST SUITE 101 MIAMI CHILDREN'S HOSPITAL
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City | MIAMI
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State | FL
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Zip | 33186-7440
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Country | US
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Telephone | 305-278-5951
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Fax | 305-278-5971
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9105386
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License Number State | FL
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