Provider Demographics
NPI:1598497398
Name:CLEMONS, CLIFFORD HENRY
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:HENRY
Last Name:CLEMONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 NW 134TH WAY APT 2-205
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-3673
Mailing Address - Country:US
Mailing Address - Phone:904-616-3260
Mailing Address - Fax:
Practice Address - Street 1:194 NW 137TH DR UNIT 100
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-2668
Practice Address - Country:US
Practice Address - Phone:352-888-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant