Healthcare Provider Details

I. General information

NPI: 1346607306
Provider Name (Legal Business Name): MATTHEW AARON CLINGMAN MSN, RN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 NEAL ZICK RD
WILLARD OH
44890-9287
US

IV. Provider business mailing address

2200 JEFFERSON AVE 5TH FL
TOLEDO OH
43604-7101
US

V. Phone/Fax

Practice location:
  • Phone: 419-993-2811
  • Fax: 419-933-4502
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.18622
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: