Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | APRN11006005 | FL |
NPI | 1124662218 |
---|---|
Provider Name | Adrienne Clayton |
First Address | Crestview, FL 32536-6541 |
Second Address | Pensacola, FL 32504-8721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2019 |
Last Update Date | 01/05/2020 |