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General NPI Number Information
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NPI Number | 1871174334
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Entity Type | Organization
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Legal Business Name | CLAR AND GRACE MEDICAL CLINIC
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Dates
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Enumeration Date | 04/16/2021
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 38439 5TH AVE PMB 174
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City | ZEPHYRHILLS
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State | FL
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Zip | 33542-4328
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Country | US
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Telephone | 813-456-2713
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Fax |
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Provider Business Mailing Address
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Address Line | 38439 5TH AVE PMB 174
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City | ZEPHYRHILLS
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State | FL
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Zip | 33542-4328
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Country | US
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Telephone | 813-456-2713
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Fax |
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Authorized Official
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Title or Position | OWNERE
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Name | BEVERLY BROOME
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Credential | ARNP
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Telephone | 813-546-2713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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