MEDICARE: CATHLYN ANN CLAY

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	11038238	FL

General Provider Information

NPI Number	:	1588468698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHLYN ANN CLAY

Provider Business Mailing Address
First Line	:	3754 SUNGROVE CIR
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-9162
Country	:	US
Telephone Number	:	480-364-4678
Fax Number	:

Provider Business Practice Location Address
First Line	:	1688 W GRANADA BLVD STE 2A
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-1818
Country	:	US
Telephone Number	:	386-425-4460
Fax Number	:

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

Provider Enumeration Date	:	04/01/2025
Last Update Date	:	04/01/2025

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