Healthcare Provider Details

I. General information

NPI: 1699387670
Provider Name (Legal Business Name): THEOPHANE CLERVIL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 GRAND CAYMAN CT
ORLANDO FL
32835-1828
US

IV. Provider business mailing address

801 GRAND CAYMAN CT
ORLANDO FL
32835-1828
US

V. Phone/Fax

Practice location:
  • Phone: 407-766-1039
  • Fax:
Mailing address:
  • Phone: 407-766-1039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9477752
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9477752
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number9477752
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: