Provider Demographics
NPI:1184854853
Name:FLUDD-ISRAEL, CHARLOTTE EUNICE
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:EUNICE
Last Name:FLUDD-ISRAEL
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 1:11814 SWEETPEA CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-6224
Mailing Address - Country:US
Mailing Address - Phone:813-765-5418
Mailing Address - Fax:813-855-5725
Practice Address - Street 1:11814 SWEETPEA CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-6224
Practice Address - Country:US
Practice Address - Phone:813-765-5418
Practice Address - Fax:813-855-5725
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL225479OtherCI# / INTERNATIONAL FITNESS ASSOCIATION