Healthcare Provider Details

I. General information

NPI: 1982995353
Provider Name (Legal Business Name): CLARE CALLAWAY KRANZ AC-CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S ORANGE AVE
ORLANDO FL
32806-1215
US

IV. Provider business mailing address

1222 S ORANGE AVE
ORLANDO FL
32806-1215
US

V. Phone/Fax

Practice location:
  • Phone: 407-649-6907
  • Fax: 407-481-2035
Mailing address:
  • Phone: 407-649-6907
  • Fax: 407-481-2035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9389186
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: