Basic Information
| Provider Information | |||||||||
| NPI: | 1467063651 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHARBONNET | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | JOANNE | ||||||||
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| Credential: | MSN, NP-C, RN-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1554 ONYX DR UNIT 402 | ||||||||
| Address2: | |||||||||
| City: | MC LEAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221023950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9852857141 | ||||||||
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| Practice Location | |||||||||
| Address1: | 902 CLINT MOORE RD STE 227 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334872800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5612416676 | ||||||||
| FaxNumber: | 5619893665 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2020 | ||||||||
| LastUpdateDate: | 11/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | F07200391 | NC | N | Allopathic & Osteopathic Physicians | Family Medicine | 363L00000X | 0024180083 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207N00000X | 0024180083 | VA | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.