Provider Demographics
NPI:1437729316
Name:CLAYBORNE, JERMAINE T (MSN, APRN, NNP-BC)
Entity Type:Individual
Prefix:
First Name:JERMAINE
Middle Name:T
Last Name:CLAYBORNE
Suffix:
Gender:M
Credentials:MSN, APRN, NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 CITY WALK WAY APT 230
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5563
Mailing Address - Country:US
Mailing Address - Phone:804-892-4818
Mailing Address - Fax:
Practice Address - Street 1:4000 CITY WALK WAY APT 230
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5563
Practice Address - Country:US
Practice Address - Phone:804-892-4818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180184363LN0005X, 363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care