Provider Demographics
NPI:1922652874
Name:BEDSOLE, CHARLOTTE (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:BEDSOLE
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 LILA ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32208-3550
Mailing Address - Country:US
Mailing Address - Phone:904-383-1001
Mailing Address - Fax:904-383-1991
Practice Address - Street 1:1255 LILA ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-3550
Practice Address - Country:US
Practice Address - Phone:904-383-1001
Practice Address - Fax:904-383-1991
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003133363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily