Provider Demographics
NPI:1225579766
Name:MCCLURE, ANGELA (ARNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 MEIZNER REAL AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8897
Mailing Address - Country:US
Mailing Address - Phone:904-982-6829
Mailing Address - Fax:
Practice Address - Street 1:2814 14TH AVE SE
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-5471
Practice Address - Country:US
Practice Address - Phone:813-652-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9344476363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner