Provider Demographics
NPI:1265462030
Name:TAVARES, CLIFTON EDWARD (BSN, RN)
Entity Type:Individual
Prefix:MR
First Name:CLIFTON
Middle Name:EDWARD
Last Name:TAVARES
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WEED ARMY COMMUNITY HOSPITAL
Mailing Address - Street 2:BLDG 166, RM 343
Mailing Address - City:FT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310
Mailing Address - Country:US
Mailing Address - Phone:760-380-2036
Mailing Address - Fax:
Practice Address - Street 1:WEED ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:BLDG 166, RM 343
Practice Address - City:FT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310
Practice Address - Country:US
Practice Address - Phone:760-380-2036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX672219163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse