Provider Demographics
NPI:1023520442
Name:KLEIN, CHARIS JUANITA (APRN)
Entity type:Individual
Prefix:
First Name:CHARIS
Middle Name:JUANITA
Last Name:KLEIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CHARIS
Other - Middle Name:JUANITA
Other - Last Name:CYR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:6809 CORAL COVE DR.
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:407-770-0661
Practice Address - Street 1:1603 S. HIAWASSEE RD.
Practice Address - Street 2:STE 130
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835
Practice Address - Country:US
Practice Address - Phone:765-730-4326
Practice Address - Fax:407-770-0661
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9344241363LF0000X
FLAPRN9344241363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023901800Medicaid