Provider Demographics
NPI:1922437433
Name:MIKAN, CHARLOTTE
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:
Last Name:MIKAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TANIA
Other - Middle Name:
Other - Last Name:DAUGHTRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4651 SALISBURY RD
Mailing Address - Street 2:SUITE 449
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6107
Mailing Address - Country:US
Mailing Address - Phone:904-418-7900
Mailing Address - Fax:904-418-7901
Practice Address - Street 1:4651 SALISBURY RD
Practice Address - Street 2:SUITE 449
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6107
Practice Address - Country:US
Practice Address - Phone:904-418-7900
Practice Address - Fax:904-418-7901
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211677376K00000X, 372600000X, 374U00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker