Provider Demographics
NPI:1881734770
Name:FLUHARTY, CHARLENE FAYE (SUPPORT COORDINATOR)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:FAYE
Last Name:FLUHARTY
Suffix:
Gender:F
Credentials:SUPPORT COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 GRADUATE WAY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-5703
Mailing Address - Country:US
Mailing Address - Phone:850-332-6644
Mailing Address - Fax:850-332-6645
Practice Address - Street 1:1706 GRADUATE WAY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-5703
Practice Address - Country:US
Practice Address - Phone:850-332-6644
Practice Address - Fax:850-332-6645
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator