Healthcare Provider Details

I. General information

NPI: 1346944550
Provider Name (Legal Business Name): CLARISSE FRES DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6671 13TH AVE N STE 1D
ST PETERSBURG FL
33710-5411
US

IV. Provider business mailing address

720 BROOKER CREEK BLVD STE 215
OLDSMAR FL
34677-2937
US

V. Phone/Fax

Practice location:
  • Phone: 727-381-1147
  • Fax: 727-345-2489
Mailing address:
  • Phone: 813-854-2003
  • Fax: 813-436-5378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS23908
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: