Provider Demographics
NPI:1437141199
Name:NARDI, CHARLES F (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:F
Last Name:NARDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 MAR WALT DR
Mailing Address - Street 2:ADMINISTRATION
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6707
Mailing Address - Country:US
Mailing Address - Phone:850-863-8131
Mailing Address - Fax:850-863-4152
Practice Address - Street 1:8990 NAVARRE PKWY
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-2216
Practice Address - Country:US
Practice Address - Phone:508-396-0108
Practice Address - Fax:850-939-4933
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2024-03-20
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
FLME71880207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110203912OtherRAILROAD MEDICARE
FL43373OtherBLUE CROSS
FL110203912OtherRAILROAD MEDICARE
G67686Medicare UPIN
FL254622100Medicaid