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General NPI Number Information
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NPI Number | 1144907429
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Entity Type | Organization
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Legal Business Name | DIVERSITY HEALTHCARE 'LLC'
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Dates
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Enumeration Date | 06/29/2023
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Last Update Date | 03/12/2026
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Provider Practice Location Address
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Address Line | 435 2ND ST NE
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City | WINTER HAVEN
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State | FL
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Zip | 33881-4103
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Country | US
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Telephone | 863-419-4422
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Fax |
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Provider Business Mailing Address
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Address Line | 1011 E MAIN ST
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City | HAINES
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State | FL
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Zip | 33844
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Country | US
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Telephone | 863-419-4422
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Fax | 833-795-1975
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | CLAYTON DALE REEDY
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Credential | MSN, APRN-C
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Telephone | 863-419-4422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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