MEDICARE: CLEAR PATH CENTER PA

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	164W00000X	Licensed Practical Nurse	PN5230304	FL

General Provider Information

NPI Number	:	1164958757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEAR PATH CENTER PA

Provider Business Mailing Address
First Line	:	3177 4TH ST N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33704-2124
Country	:	US
Telephone Number	:	877-585-2955
Fax Number	:	877-352-4960

Provider Business Practice Location Address
First Line	:	3177 4TH ST N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33704-2124
Country	:	US
Telephone Number	:	877-585-2955
Fax Number	:	877-352-4960

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAWNE ERA
Credential	:	LCSW
Telephone Number	:	877-585-2955

Provider Enumeration Date	:	05/03/2017
Last Update Date	:	05/03/2017

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