Provider Demographics
NPI:1184204018
Name:CHARLERY, EUGINIE CELESTINA (APRN)
Entity type:Individual
Prefix:
First Name:EUGINIE
Middle Name:CELESTINA
Last Name:CHARLERY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 HOME GROVE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-6502
Mailing Address - Country:US
Mailing Address - Phone:407-978-3295
Mailing Address - Fax:
Practice Address - Street 1:300 SEASIDE AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4603
Practice Address - Country:US
Practice Address - Phone:203-301-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9444967163W00000X
CT12.013847363LA2100X
CT222701163W00000X
FL001445363LA2100X
FLAPRN11010892363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN9444967OtherSTATE OF FLORIDA, DEPARTMENT OF HEALTH, DIVISION OF MEDICAL QUALITY ASSURANCE
FLAPRN11010892OtherSTATE OF FLORIDA, DEPARTMENT OF HEALTH, DIVISION OF MEDICAL QUALITY ASSURANCE