Provider Demographics
NPI:1124538764
Name:CHARLES, PATRICK HARRY (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:HARRY
Last Name:CHARLES
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8229 PACIFIC BEACH DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-7974
Mailing Address - Country:US
Mailing Address - Phone:305-652-6203
Mailing Address - Fax:
Practice Address - Street 1:8229 PACIFIC BEACH DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-7974
Practice Address - Country:US
Practice Address - Phone:305-652-6203
Practice Address - Fax:305-652-6203
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60961251363LP0808X
NH077529-23363LP0808X
FL9254956363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty