Provider Demographics
NPI:1124362199
Name:CHARLES, CLEON ELAINA (RN)
Entity Type:Individual
Prefix:MS
First Name:CLEON
Middle Name:ELAINA
Last Name:CHARLES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4613 N UNIVERSITY DR # 609
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4602
Mailing Address - Country:US
Mailing Address - Phone:347-337-9741
Mailing Address - Fax:
Practice Address - Street 1:2156 STRANG AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-2335
Practice Address - Country:US
Practice Address - Phone:347-337-9741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9341682163W00000X
NY638903163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered Nurse