Provider Demographics
NPI:1598196925
Name:JOHN, CHARMAIN CAROL (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CHARMAIN
Middle Name:CAROL
Last Name:JOHN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17325 PAGONIA RD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6008
Mailing Address - Country:US
Mailing Address - Phone:407-905-6014
Mailing Address - Fax:407-636-7808
Practice Address - Street 1:17325 PAGONIA RD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6008
Practice Address - Country:US
Practice Address - Phone:407-905-6014
Practice Address - Fax:407-636-7808
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9199463363LA2200X
FLAPRN9199463363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010691400Medicaid