Provider Demographics
NPI:1699387670
Name:CLERVIL, THEOPHANE (RN)
Entity Type:Individual
Prefix:MISS
First Name:THEOPHANE
Middle Name:
Last Name:CLERVIL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 GRAND CAYMAN CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-1828
Mailing Address - Country:US
Mailing Address - Phone:407-766-1039
Mailing Address - Fax:
Practice Address - Street 1:801 GRAND CAYMAN CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-1828
Practice Address - Country:US
Practice Address - Phone:407-766-1039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9477752163WA2000X, 163WI0500X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy