Healthcare Provider Details

I. General information

NPI: 1821063314
Provider Name (Legal Business Name): CLAUDIA I KLENCK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13241 BARTRAM PARK BLVD SUITE 209
JACKSONVILLE FL
32258-5212
US

IV. Provider business mailing address

13241 BARTRAM PARK BLVD SUITE 209
JACKSONVILLE FL
32258-5212
US

V. Phone/Fax

Practice location:
  • Phone: 904-242-4220
  • Fax: 904-551-1502
Mailing address:
  • Phone: 904-242-4220
  • Fax: 904-551-1502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number056581
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberME99572
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: