Provider Demographics
NPI:1740722719
Name:CALVERT, CHARLENE MARIE (LPN)
Entity type:Individual
Prefix:MISS
First Name:CHARLENE
Middle Name:MARIE
Last Name:CALVERT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:CHARLENE
Other - Middle Name:MARIE
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:135 HAWK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:FL
Mailing Address - Zip Code:32333-4145
Mailing Address - Country:US
Mailing Address - Phone:850-539-0283
Mailing Address - Fax:
Practice Address - Street 1:135 HAWK RIDGE DR
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:FL
Practice Address - Zip Code:32333-4145
Practice Address - Country:US
Practice Address - Phone:850-539-0283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5207537164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse