Provider Demographics
NPI:1891015376
Name:O'NEIL, CHARLA JO (CNM ARNP)
Entity Type:Individual
Prefix:
First Name:CHARLA
Middle Name:JO
Last Name:O'NEIL
Suffix:
Gender:F
Credentials:CNM ARNP
Other - Prefix:
Other - First Name:CHARLA
Other - Middle Name:JO
Other - Last Name:WARDLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM ARNP
Mailing Address - Street 1:660 GLADES RD STE 340
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6468
Mailing Address - Country:US
Mailing Address - Phone:561-488-1801
Mailing Address - Fax:561-451-1480
Practice Address - Street 1:660 GLADES RD STE 340
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6468
Practice Address - Country:US
Practice Address - Phone:561-488-1801
Practice Address - Fax:561-451-1480
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK95687363LX0001X
FL9373487ARNP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology