Provider Demographics
NPI:1003469602
Name:CLEMENT, GERALD
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:CLEMENT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 S KIRKMAN RD APT 2082
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-2598
Mailing Address - Country:US
Mailing Address - Phone:407-274-2101
Mailing Address - Fax:
Practice Address - Street 1:1481 S KIRKMAN RD APT 2082
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-2598
Practice Address - Country:US
Practice Address - Phone:407-274-2101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL271150376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide