Provider Demographics
NPI:1114640414
Name:CLINTON, JOANN (AGACNP)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:CLINTON
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27070 BROOKVIEW CT
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48134-9066
Mailing Address - Country:US
Mailing Address - Phone:248-231-5737
Mailing Address - Fax:
Practice Address - Street 1:27070 BROOKVIEW CT
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48134-9066
Practice Address - Country:US
Practice Address - Phone:248-231-5737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704331080363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner