Healthcare Provider Details

I. General information

NPI: 1114926037
Provider Name (Legal Business Name): ANDREA H CLAYMAN GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANDREA VOGEL CLAYMAN GNP

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11812 CRUSSELLE DR
JACKSONVILLE FL
32223-0876
US

IV. Provider business mailing address

11812 CRUSSELLE DR
JACKSONVILLE FL
32223-0876
US

V. Phone/Fax

Practice location:
  • Phone: 904-252-5265
  • Fax:
Mailing address:
  • Phone: 904-252-5265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN078635 AP01911
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: