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General NPI Number Information
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NPI Number | 1568611002
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Entity Type | Individual
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Provider Name | MR. CLARENCE EDWARD TURNER
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Gender | Male
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Dates
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Enumeration Date | 09/09/2008
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Last Update Date | 09/09/2008
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Provider Practice Location Address
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Address Line | 2357 SE WEST BLACKWELL DRIVE
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City | PORT ST LUCIE
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State | FL
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Zip | 34952
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Country | US
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Telephone | 772-607-2253
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Fax | 772-335-3314
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Provider Business Mailing Address
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Address Line | 2357 SE WEST BLACKWELL DRIVE
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City | PORT ST LUCIE
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State | FL
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Zip | 34952
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Country | US
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Telephone | 772-607-2253
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Fax | 772-335-3314
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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 | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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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 | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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