Provider Demographics
NPI:1700400397
Name:MCLAREN, JUDA (PBT (ASCP))
Entity Type:Individual
Prefix:
First Name:JUDA
Middle Name:
Last Name:MCLAREN
Suffix:
Gender:F
Credentials:PBT (ASCP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-7336
Mailing Address - Country:US
Mailing Address - Phone:689-333-5188
Mailing Address - Fax:
Practice Address - Street 1:1015 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7336
Practice Address - Country:US
Practice Address - Phone:689-333-5188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-30
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22-0830202K00000X
FL225700000X, 183700000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No183700000XPharmacy Service ProvidersPharmacy Technician