Provider Demographics
NPI:1891253860
Name:CHARLES, KATELYNN JERRICA (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KATELYNN
Middle Name:JERRICA
Last Name:CHARLES
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:306 LINCOLN RD FL 33139
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3103
Mailing Address - Country:US
Mailing Address - Phone:305-531-5583
Mailing Address - Fax:
Practice Address - Street 1:306 LINCOLN RD # 5010
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-3103
Practice Address - Country:US
Practice Address - Phone:305-531-5583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11001591363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily