MEDICARE: CLARE HUSTON INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1114481959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARE HUSTON INC

Provider Business Mailing Address
First Line	:	12058 SAN JOSE BLVD STE 802
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8667
Country	:	US
Telephone Number	:	904-910-9060
Fax Number	:	904-372-6087

Provider Business Practice Location Address
First Line	:	12058 SAN JOSE BLVD STE 802
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-8667
Country	:	US
Telephone Number	:	904-910-9060
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CLARE BENJAMIN
Credential	:	ARNP
Telephone Number	:	904-910-9060

Provider Enumeration Date	:	01/25/2019
Last Update Date	:	07/22/2021

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Directions to “CLARE HUSTON INC ” Practice Location

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