Provider Demographics
NPI:1972851244
Name:CHARRON, ELIZABETH (LM, CPM)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:CHARRON
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 SE 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7620
Mailing Address - Country:US
Mailing Address - Phone:561-455-2703
Mailing Address - Fax:561-560-8852
Practice Address - Street 1:236 SE 23RD AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7620
Practice Address - Country:US
Practice Address - Phone:561-455-2703
Practice Address - Fax:561-560-8852
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL341261QB0400X
FLMW283176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009785100Medicaid