=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013351295
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENEA KATHLEEN CLOWDSLEY APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2013
-----------------------------------------------------
Last Update Date | 04/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1101 GULF BREEZE PKWY STE 14
-----------------------------------------------------
City | GULF BREEZE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32561-4892
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-990-9100
-----------------------------------------------------
Fax | 850-396-0142
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 OCEAN VIEW DR
-----------------------------------------------------
City | PENSACOLA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32561-2436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-384-6256
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN9247184
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------