Active NPI
Charlie Joe Nugent, LCP, CCP
- Surgical Technologist
- Oakland Park, FL
National Provider Identifier
1801511597
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Technologist
- License
- 167
- Practice address
- 1640 W Oakland Park Blvd
Oakland Park, FL 33311-1538 - Phone
- (954) 939-0274
- Fax
- (954) 337-0760
- NPI assigned
- Oct 5, 2022
- Last updated
- Oct 5, 2022
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Surgical Technologist | 246ZS0410X | 167 | TN | Primary |
Addresses
Primary practice location
1640 W Oakland Park Blvd
Oakland Park, FL 33311-1538
Mailing address
4305 Sango Rd
Clarksville, TN 37043-7307
Phone (931) 624-0020
Other practice location 1
4305 Sango Rd
Clarksville, TN 37043-7307
Phone (954) 939-0274
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Hospital | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 167 | TN | MD | Surgical Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664928000000",
"number": "1801511597",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4305 SANGO RD",
"city": "CLARKSVILLE",
"state": "TN",
"postal_code": "370437307",
"telephone_number": "931-624-0020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1640 W OAKLAND PARK BLVD",
"city": "OAKLAND PARK",
"state": "FL",
"postal_code": "333111538",
"telephone_number": "954-939-0274",
"fax_number": "954-337-0760"
}
],
"practiceLocations": [
{
"address_1": "4305 Sango Rd",
"address_purpose": "LOCATION",
"city": "Clarksville",
"state": "TN",
"postal_code": "370437307",
"country_code": "US",
"telephone_number": "954-939-0274",
"fax_number": "954-939-0274",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NUGENT",
"first_name": "CHARLIE",
"middle_name": "JOE",
"credential": "LCP, CCP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-10-05",
"last_updated": "2022-10-05",
"certification_date": "2022-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "246ZS0410X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Technologist",
"state": "TN",
"license": "167",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Hospital",
"affiliation": "N",
"endpointDescription": "Hospital",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "2000 Church St",
"city": "Nashville",
"state": "TN",
"country_code": "US",
"postal_code": "372364400",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Oakland Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.