Healthcare Provider Details

I. General information

NPI: 1295352185
Provider Name (Legal Business Name): ERICA CLIPPS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 SW HIGHWAY 351
CROSS CITY FL
32628-3827
US

IV. Provider business mailing address

2804 REMINGTON GREEN CIR STE 2
TALLAHASSEE FL
32308-1550
US

V. Phone/Fax

Practice location:
  • Phone: 524-983-3493
  • Fax: 352-498-0716
Mailing address:
  • Phone: 850-385-4494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11004662
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: