Provider Demographics
NPI:1467063651
Name:CHARBONNET, PAULA JOANNE (MSN, NP-C, RN-C)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:JOANNE
Last Name:CHARBONNET
Suffix:
Gender:F
Credentials:MSN, NP-C, RN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1554 ONYX DR UNIT 402
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3950
Mailing Address - Country:US
Mailing Address - Phone:985-285-7141
Mailing Address - Fax:
Practice Address - Street 1:902 CLINT MOORE RD STE 227
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2800
Practice Address - Country:US
Practice Address - Phone:561-241-6676
Practice Address - Fax:561-989-3665
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCF07200391207Q00000X
VA0024180083363L00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner