Healthcare Provider Details

I. General information

NPI: 1538398441
Provider Name (Legal Business Name): JILLIAN CLAVENNA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 W BAY DR STE C
LARGO FL
33770-2285
US

IV. Provider business mailing address

PO BOX 23329
NEW YORK NY
10087-3329
US

V. Phone/Fax

Practice location:
  • Phone: 727-935-0500
  • Fax: 727-935-0501
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9109794
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: