Provider Demographics
NPI:1710522016
Name:CHARLES, ABBDADY (APRN)
Entity Type:Individual
Prefix:
First Name:ABBDADY
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2839 TAYLOR ST APT 8
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4277
Mailing Address - Country:US
Mailing Address - Phone:862-218-4774
Mailing Address - Fax:
Practice Address - Street 1:2839 TAYLOR ST APT 8
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4277
Practice Address - Country:US
Practice Address - Phone:862-218-4774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-10
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004480363LA2200X
FLAPRN11004480363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health