Healthcare Provider Details

I. General information

NPI: 1609818145
Provider Name (Legal Business Name): CLINICARE CLINICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 09/05/2021
Certification Date: 09/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 SUNNYDALE BLVD STE B
CLEARWATER FL
33765-1207
US

IV. Provider business mailing address

PO BOX 16264
CLEARWATER FL
33766-6264
US

V. Phone/Fax

Practice location:
  • Phone: 727-796-2904
  • Fax: 866-961-5586
Mailing address:
  • Phone: 727-796-2904
  • Fax: 727-796-2965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. KIMBERLY ANN JOHNS
Title or Position: CEO
Credential:
Phone: 727-796-2904