Healthcare Provider Details

I. General information

NPI: 1295298537
Provider Name (Legal Business Name): CLAIRE ELIZABETH RAWLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6271 SAINT AUGUSTINE RD STE 1
JACKSONVILLE FL
32217-2555
US

IV. Provider business mailing address

PO BOX 44008
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 302-388-8217
  • Fax:
Mailing address:
  • Phone: 302-388-8217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberME174299
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: