Provider Demographics
NPI:1215678495
Name:CHARLES, ALLISON (FNP)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 29650 DEPT # 880392
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038
Mailing Address - Country:US
Mailing Address - Phone:804-626-1746
Mailing Address - Fax:804-626-2690
Practice Address - Street 1:10147 GRAND AVE STE C4
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3435
Practice Address - Country:US
Practice Address - Phone:480-616-0676
Practice Address - Fax:602-742-0315
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ273400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily