Healthcare Provider Details

I. General information

NPI: 1447995469
Provider Name (Legal Business Name): CLADE ESSENTIALS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E KENNEDY BLVD
TAMPA FL
33602-5179
US

IV. Provider business mailing address

19046 BRUCE B DOWNS BLVD STE B6
TAMPA FL
33647-2434
US

V. Phone/Fax

Practice location:
  • Phone: 813-444-8833
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102X00000X
TaxonomyPoetry Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JESSIE FRANK
Title or Position: PRESIDENT
Credential:
Phone: 813-784-1623