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General NPI Number Information
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NPI Number | 1932384344
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Entity Type | Individual
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Provider Name | ANDREA KATRINA CLAYTON PROVIDER
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Gender | Female
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 03/24/2020
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Provider Practice Location Address
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Address Line | 4121 NE 15TH ST APT 107
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City | GAINESVILLE
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State | FL
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Zip | 32609-2061
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Country | US
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Telephone | 352-213-5624
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Fax | 352-451-4914
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Provider Business Mailing Address
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Address Line | 4121 NE 15TH ST APT 107
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City | GAINESVILLE
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State | FL
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Zip | 32609-2061
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Country | US
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Telephone | 352-213-5624
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Fax | 352-451-4914
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 39971191
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 39971191
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License Number State | FL
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