Provider Demographics
NPI:1073243341
Name:CHARLOTIN, SUDLAIRE THERESA (MSN, RN, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:SUDLAIRE
Middle Name:THERESA
Last Name:CHARLOTIN
Suffix:
Gender:F
Credentials:MSN, RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SW 1ST AVE APT 3115
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-4400
Mailing Address - Country:US
Mailing Address - Phone:954-909-1044
Mailing Address - Fax:
Practice Address - Street 1:301 SW 1ST AVE APT 3115
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-4400
Practice Address - Country:US
Practice Address - Phone:954-909-1044
Practice Address - Fax:954-909-1044
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNUCC363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily