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General NPI Number Information
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NPI Number | 1003469602
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Entity Type | Individual
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Provider Name | GERALD CLEMENT
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Gender | Male
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Dates
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Enumeration Date | 07/23/2019
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Last Update Date | 07/23/2019
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Provider Practice Location Address
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Address Line | 1481 S KIRKMAN RD APT 2082
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City | ORLANDO
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State | FL
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Zip | 32811-2598
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Country | US
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Telephone | 407-274-2101
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Fax |
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Provider Business Mailing Address
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Address Line | 1481 S KIRKMAN RD APT 2082
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City | ORLANDO
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State | FL
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Zip | 32811-2598
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Country | US
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Telephone | 407-274-2101
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 271150
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License Number State | FL
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