Provider Demographics
NPI:1275288060
Name:RENFROE, CLYDE WILLIAM (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:CLYDE
Middle Name:WILLIAM
Last Name:RENFROE
Suffix:
Gender:M
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22829 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-5227
Mailing Address - Country:US
Mailing Address - Phone:813-915-5459
Mailing Address - Fax:813-345-8172
Practice Address - Street 1:22829 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-5227
Practice Address - Country:US
Practice Address - Phone:813-915-5459
Practice Address - Fax:813-345-8172
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11017161363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner