Healthcare Provider Details

I. General information

NPI: 1144717174
Provider Name (Legal Business Name): CLAUDINISE CIVIL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 PALM BEACH LAKES BLVD
WEST PALM BEACH FL
33409-6501
US

IV. Provider business mailing address

2007 PALM BEACH LAKES BLVD
WEST PALM BEACH FL
33409-6501
US

V. Phone/Fax

Practice location:
  • Phone: 561-688-5808
  • Fax:
Mailing address:
  • Phone: 615-688-5808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF344310
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9385780
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: