Provider Demographics
NPI:1780292383
Name:CHARLES, MICHAEL S (FNP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:CHARLES
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S INGLESIDE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1803
Mailing Address - Country:US
Mailing Address - Phone:251-990-1920
Mailing Address - Fax:251-990-1921
Practice Address - Street 1:150 S INGLESIDE ST
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1803
Practice Address - Country:US
Practice Address - Phone:251-990-1920
Practice Address - Fax:251-990-1921
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-110315363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily