Healthcare Provider Details

I. General information

NPI: 1477466456
Provider Name (Legal Business Name): DIOVIONNE JORELL MARIE CLIFTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 W PENSACOLA ST
TALLAHASSEE FL
32304-2888
US

IV. Provider business mailing address

808 PALM RIDGE DR
IMMOKALEE FL
34142-4224
US

V. Phone/Fax

Practice location:
  • Phone: 850-575-4388
  • Fax:
Mailing address:
  • Phone: 239-658-4633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: