Provider Demographics
NPI:1578790366
Name:KINGSLEY, CHARON
Entity Type:Individual
Prefix:
First Name:CHARON
Middle Name:
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350SW130THAVE.,33027
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5350 SW 130TH AVE
Practice Address - Street 2:1660 NORTHWEST 7TH COURT
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-5410
Practice Address - Country:US
Practice Address - Phone:305-200-1778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1522202363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily