Provider Demographics
NPI:1851428064
Name:CHARLES, SHAWNA (DNP)
Entity Type:Individual
Prefix:DR
First Name:SHAWNA
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 848182
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33084-0182
Mailing Address - Country:US
Mailing Address - Phone:954-990-0461
Mailing Address - Fax:954-990-0465
Practice Address - Street 1:10472 TAFT ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-2819
Practice Address - Country:US
Practice Address - Phone:954-990-0461
Practice Address - Fax:954-990-0465
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1956772363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306092600Medicaid
FLQO5846Medicare UPIN
FLU1929YMedicare PIN