Active NPI
Charlene Ann Demers, ARNP
- Gerontology Nurse Practitioner
- Melbourne, FL
National Provider Identifier
1407867336
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- 775172
- Practice address
- 4450 W. Eau Gallie Blvd
Suite 250
Melbourne, FL 32034 - Phone
- (321) 751-6671
- Fax
- (407) 339-4903
- NPI assigned
- Aug 9, 2006
- Last updated
- Mar 1, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | 775172 | FL | Primary |
Addresses
Primary practice location
4450 W. Eau Gallie Blvd
Suite 250
Melbourne, FL 32034
Mailing address
4450 W. Eau Gallie Blvd
Suite 250
Melbourne, FL 32034
Phone (321) 751-6671
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 307328900 | Medicaid | FL | |
| RR MEDICARE | Other | FL | P00293656 |
Other names 1
- Charlene Ann Standifer
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 775172 | FL | MD | Gerontology Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551398400000",
"number": "1407867336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4450 W. EAU GALLIE BLVD",
"address_2": "SUITE 250",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "32034",
"telephone_number": "321-751-6671",
"fax_number": "407-339-4903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4450 W. EAU GALLIE BLVD",
"address_2": "SUITE 250",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "32034",
"telephone_number": "321-751-6671",
"fax_number": "407-339-4903"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEMERS",
"first_name": "CHARLENE",
"middle_name": "ANN",
"credential": "ARNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-09",
"last_updated": "2019-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "FL",
"license": "775172",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "307328900",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "P00293656",
"identifier": "RR MEDICARE",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "CHARLENE",
"last_name": "STANDIFER",
"middle_name": "ANN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.