Provider Demographics
NPI:1932832516
Name:CHARLES, NONO (SURGICAL ASSISTANT)
Entity type:Individual
Prefix:DR
First Name:NONO
Middle Name:
Last Name:CHARLES
Suffix:
Gender:M
Credentials:SURGICAL ASSISTANT
Other - Prefix:DR
Other - First Name:NONO
Other - Middle Name:
Other - Last Name:CHARLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:335 NW 34TH ST APT 203
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-2820
Mailing Address - Country:US
Mailing Address - Phone:954-451-8504
Mailing Address - Fax:
Practice Address - Street 1:335 NW 34TH ST APT 203
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-2820
Practice Address - Country:US
Practice Address - Phone:954-451-8504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22-386246ZC0007X
363AS0400X
TN22-386246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical