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General NPI Number Information
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NPI Number | 1891604963
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Entity Type | Individual
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Provider Name | CHARLENE ALIE
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Gender |
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Dates
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Enumeration Date | 09/03/2026
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Last Update Date | 09/03/2026
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Provider Practice Location Address
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Address Line | 541 WINTER GARDEN VINELAND RD
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City | WINTER GARDEN
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State | FL
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Zip | 34787-5207
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Country | US
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Telephone | 689-686-8880
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Fax |
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Provider Business Mailing Address
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Address Line | 14821 TULLAMORE LOOP
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City | WINTER GARDEN
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State | FL
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Zip | 34787-5336
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Country | US
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Telephone | 407-398-4497
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | APRN11050121
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License Number State | FL
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