Provider Demographics
NPI:1033350012
Name:DE LA PENA, CHARON DENICE
Entity Type:Individual
Prefix:MRS
First Name:CHARON
Middle Name:DENICE
Last Name:DE LA PENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12861 SW 38TH CIR
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34473-2718
Mailing Address - Country:US
Mailing Address - Phone:352-307-3908
Mailing Address - Fax:
Practice Address - Street 1:937 SW 19TH AVENUE RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-2046
Practice Address - Country:US
Practice Address - Phone:352-867-1226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 89244376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide