Healthcare Provider Details

I. General information

NPI: 1477967081
Provider Name (Legal Business Name): CLARISSE DEWBERRY SIEGEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. CLARISSE PATRICIA DEWBERRY

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 PINELLAS ST STE 400
CLEARWATER FL
33756-3356
US

IV. Provider business mailing address

455 PINELLAS ST STE 400
CLEARWATER FL
33756-3356
US

V. Phone/Fax

Practice location:
  • Phone: 727-445-1911
  • Fax: 727-445-1986
Mailing address:
  • Phone: 727-445-1911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9109935
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: