MEDICARE: MRS. ANNIE MILDRED CLAVON NURSE PRACTITIONER

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	363L00000X	Nurse Practitioner	1448002	FL
2	363LF0000X	Family Nurse Practitioner	1448002	FL

General Provider Information

NPI Number	:	1760587513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNIE MILDRED CLAVON NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	2323 NW 19TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-3400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2323 NW 19TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-3400
Country	:	US
Telephone Number	:	954-484-9590
Fax Number	:	954-486-5690

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	09/11/2025

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