Provider Demographics
NPI:1013196484
Name:CHARLES, TESS C (PA-C)
Entity Type:Individual
Prefix:
First Name:TESS
Middle Name:C
Last Name:CHARLES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:4440 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3535
Mailing Address - Country:US
Mailing Address - Phone:786-564-1810
Mailing Address - Fax:
Practice Address - Street 1:2550 N THUNDERBIRD CIR
Practice Address - Street 2:SUITE 303
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-1214
Practice Address - Country:US
Practice Address - Phone:480-289-7890
Practice Address - Fax:480-455-4940
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA 9103587363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant