Basic Information
| Provider Information | |||||||||
| NPI: | 1891015376 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'NEIL | ||||||||
| FirstName: | CHARLA | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | |||||||||
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| Credential: | CNM ARNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WARDLON | ||||||||
| OtherFirstName: | CHARLA | ||||||||
| OtherMiddleName: | JO | ||||||||
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| OtherCredential: | CNM ARNP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 880 NW 13TH STREET | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614132832 | ||||||||
| FaxNumber: | 8887346559 | ||||||||
| Practice Location | |||||||||
| Address1: | 880 NW 13TH STREET | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614132832 | ||||||||
| FaxNumber: | 8887346559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2010 | ||||||||
| LastUpdateDate: | 09/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | 95687 | OK | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | 367A00000X | 9373487ARNP | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.