Healthcare Provider Details

I. General information

NPI: 1053199604
Provider Name (Legal Business Name): EGAN CLEARWATER HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19321 US HIGHWAY 19 N
CLEARWATER FL
33764-3169
US

IV. Provider business mailing address

19321 US HIGHWAY 19 N
CLEARWATER FL
33764-3169
US

V. Phone/Fax

Practice location:
  • Phone: 801-360-7973
  • Fax:
Mailing address:
  • Phone: 801-360-7973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BRENT H EGAN
Title or Position: OWNER/ PRESIDENT
Credential: NP
Phone: 801-360-7973