Provider Demographics
NPI:1467934877
Name:JEAN CHARLES, FRITZ
Entity Type:Individual
Prefix:
First Name:FRITZ
Middle Name:
Last Name:JEAN CHARLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2614
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-2614
Mailing Address - Country:US
Mailing Address - Phone:407-496-9313
Mailing Address - Fax:
Practice Address - Street 1:6446 S GOLDENROD RD UNIT B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-3443
Practice Address - Country:US
Practice Address - Phone:407-496-9313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL678765343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)