Healthcare Provider Details

I. General information

NPI: 1164237673
Provider Name (Legal Business Name): DEANNA MARIA KLIDIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12899 WALSINGHAM RD
LARGO FL
33774-3537
US

IV. Provider business mailing address

2995 DREW ST
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 727-596-9490
  • Fax:
Mailing address:
  • Phone: 727-281-9065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11035692
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: