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General NPI Number Information
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NPI Number | 1932848801
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Entity Type | Organization
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Legal Business Name | ST. CHARLES WELLNESS CENTER
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Dates
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Enumeration Date | 05/31/2022
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 311 NE 8TH ST STE 109
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City | HOMESTEAD
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State | FL
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Zip | 33030-4734
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Country | US
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Telephone | 305-363-5573
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Fax | 786-622-1893
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Provider Business Mailing Address
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Address Line | 311 NE 8TH ST STE 109
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City | HOMESTEAD
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State | FL
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Zip | 33030-4734
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Country | US
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Telephone | 305-363-5573
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Fax | 786-622-1893
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Authorized Official
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Title or Position | PROVIDER
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Name | ROSITA ATILUS
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Credential | DNP, APRN, FNP-BC
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Telephone | 786-259-2966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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