Provider Demographics
NPI:1225873540
Name:CHARLES, ESTHER
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:CHARLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10544 SW 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-1748
Mailing Address - Country:US
Mailing Address - Phone:954-610-5532
Mailing Address - Fax:
Practice Address - Street 1:2900 W CYPRESS CREEK RD STE 5
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1715
Practice Address - Country:US
Practice Address - Phone:954-343-6552
Practice Address - Fax:754-255-7455
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11032552363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health