Provider Demographics
NPI:1407867336
Name:DEMERS, CHARLENE ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:ANN
Last Name:DEMERS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:ANN
Other - Last Name:STANDIFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4450 W. EAU GALLIE BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32034
Mailing Address - Country:US
Mailing Address - Phone:321-751-6671
Mailing Address - Fax:407-339-4903
Practice Address - Street 1:4450 W. EAU GALLIE BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32034
Practice Address - Country:US
Practice Address - Phone:321-751-6671
Practice Address - Fax:407-339-4903
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL775172363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307328900Medicaid
FLRR MEDICAREOtherP00293656
FLQ65082Medicare UPIN
FLU6688ZMedicare ID - Type Unspecified