Provider Demographics
NPI:1841599438
Name:AGUIRRE, CHARMAINE A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARMAINE
Middle Name:A
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SAWGRASS VILLAGE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-5048
Mailing Address - Country:US
Mailing Address - Phone:904-285-9355
Mailing Address - Fax:
Practice Address - Street 1:1100 SAWGRASS VILLAGE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-5048
Practice Address - Country:US
Practice Address - Phone:904-285-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0120064207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine