Provider Demographics
NPI:1972065597
Name:JEAN-CHARLES, ALICE
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:JEAN-CHARLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16725 NW 25TH CT
Mailing Address - Street 2:
Mailing Address - City:CAROL CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33056-4522
Mailing Address - Country:US
Mailing Address - Phone:305-761-3572
Mailing Address - Fax:
Practice Address - Street 1:1100 NW 95TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33150-2038
Practice Address - Country:US
Practice Address - Phone:305-835-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95049462163WG0000X
FLRN9367671163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice