Healthcare Provider Details

I. General information

NPI: 1053899807
Provider Name (Legal Business Name): TABITHA FAITH CLAYTON ARNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 W MILLER ST
ORLANDO FL
32806-2031
US

IV. Provider business mailing address

83 W MILLER ST
ORLANDO FL
32806-2031
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-5281
  • Fax: 407-648-9879
Mailing address:
  • Phone: 321-841-5281
  • Fax: 407-648-9879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number9377992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: