MEDICARE: JERRY CHARLES JR. NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN2348883	MA

General Provider Information

NPI Number	:	1508338567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY CHARLES JR. NP

Provider Business Mailing Address
First Line	:	1340 BOYLSTON ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02215-4302
Country	:	US
Telephone Number	:	617-267-0900
Fax Number	:	617-867-8646

Provider Business Practice Location Address
First Line	:	2161 PALM BEACH LAKES BLVD STE 208
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-6611
Country	:	US
Telephone Number	:	561-899-3199
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2018
Last Update Date	:	02/17/2026

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