MEDICARE: MS. MAUREEN LAUREN CLANCY ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2566322	FL

General Provider Information

NPI Number	:	1033192323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAUREEN LAUREN CLANCY ARNP

Provider Business Mailing Address
First Line	:	3034 NE QUAYSIDE LN
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2258
Country	:	US
Telephone Number	:	305-389-9487
Fax Number	:	786-662-5314

Provider Business Practice Location Address
First Line	:	6200 SUNSET DR
Second Line	:	SUITE 304
City	:	SOUTH MIAMI
State	:	FL
Zip	:	33143-4828
Country	:	US
Telephone Number	:	305-662-1550
Fax Number	:	305-662-5930

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	08/26/2010

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