Provider Demographics
NPI:1417329665
Name:JEAN CHARLES, MARIE ERONNE (ARNP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ERONNE
Last Name:JEAN CHARLES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:ERONNE
Other - Last Name:JEAN CHARLES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP/ FNP
Mailing Address - Street 1:6901 CYPRESS RD APT A15
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2301
Mailing Address - Country:US
Mailing Address - Phone:954-657-1877
Mailing Address - Fax:
Practice Address - Street 1:6901 CYPRESS ROAD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317
Practice Address - Country:US
Practice Address - Phone:954-657-1877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9377767363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily