Provider Demographics
NPI:1033192323
Name:CLANCY, MAUREEN LAUREN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:LAUREN
Last Name:CLANCY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3034 NE QUAYSIDE LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2258
Mailing Address - Country:US
Mailing Address - Phone:305-389-9487
Mailing Address - Fax:786-662-5314
Practice Address - Street 1:6200 SUNSET DR
Practice Address - Street 2:SUITE 304
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4828
Practice Address - Country:US
Practice Address - Phone:305-662-1550
Practice Address - Fax:305-662-5930
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2566322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily