Healthcare Provider Details

I. General information

NPI: 1902159320
Provider Name (Legal Business Name): DIANNE CLAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7441 CLARCONA OCOEE RD
ORLANDO FL
32818-1211
US

IV. Provider business mailing address

7441 CLARCONA OCOEE RD
ORLANDO FL
32818-1211
US

V. Phone/Fax

Practice location:
  • Phone: 407-394-2397
  • Fax: 407-290-9509
Mailing address:
  • Phone: 407-394-2397
  • Fax: 407-290-9509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: DIANNE E CLAY
Title or Position: HOME HEALTH/ MEDICAL ASSISTANT
Credential:
Phone: 407-394-2397