Provider Demographics
NPI:1205108495
Name:CHARLES, LYONIE HERODIA (ARNP-C)
Entity type:Individual
Prefix:MS
First Name:LYONIE
Middle Name:HERODIA
Last Name:CHARLES
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11054 57TH RD N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-8852
Mailing Address - Country:US
Mailing Address - Phone:561-714-0372
Mailing Address - Fax:
Practice Address - Street 1:860 US 1
Practice Address - Street 2:STE 102C
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-3879
Practice Address - Country:US
Practice Address - Phone:561-282-3924
Practice Address - Fax:844-687-7509
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9239497363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009514100Medicaid
FL009514100Medicaid