Provider Demographics
NPI:1114926037
Name:CLAYMAN, ANDREA H (GNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:H
Last Name:CLAYMAN
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:VOGEL
Other - Last Name:CLAYMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:GNP
Mailing Address - Street 1:11812 CRUSSELLE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-0876
Mailing Address - Country:US
Mailing Address - Phone:904-252-5265
Mailing Address - Fax:
Practice Address - Street 1:11812 CRUSSELLE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-0876
Practice Address - Country:US
Practice Address - Phone:904-252-5265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN078635 AP01911363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1685607Medicaid
LA1685607Medicaid
LA5X504Medicare ID - Type Unspecified