Provider Demographics
NPI:1508124116
Name:WASHINGTON, DEMETRIUS MCCLINTON (FNP)
Entity Type:Individual
Prefix:MRS
First Name:DEMETRIUS
Middle Name:MCCLINTON
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3440 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 460
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6927
Mailing Address - Country:US
Mailing Address - Phone:714-271-9843
Mailing Address - Fax:186-698-6226
Practice Address - Street 1:1155 S SUMMER BREEZE LN
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-2529
Practice Address - Country:US
Practice Address - Phone:714-271-9843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21078363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily