Basic Information
Provider Information
NPI: 1962051805
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PEREZ-CHARTON
FirstName: DIANA
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: APRN, MSN, RN
OtherOrganizationName:  
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OtherCredential:  
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Mailing Information
Address1: 2675 WINKLER AVE FL 2
Address2:  
City: FORT MYERS
State: FL
PostalCode: 339019342
CountryCode: US
TelephoneNumber: 8778563774
FaxNumber: 2395992612
Practice Location
Address1: 2350 VANDERBILT BEACH RD STE 201
Address2:  
City: NAPLES
State: FL
PostalCode: 341092760
CountryCode: US
TelephoneNumber: 2395925864
FaxNumber: 2395926214
Other Information
ProviderEnumerationDate: 09/04/2019
LastUpdateDate: 10/07/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPRN9308713FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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