Provider Demographics
NPI:1740584796
Name:PORTER, CLAUDETTE (MSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:CLAUDETTE
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 STRATHMORE CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5442
Mailing Address - Country:US
Mailing Address - Phone:754-245-0586
Mailing Address - Fax:
Practice Address - Street 1:4821 NW 22ND CT APT 108
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-3408
Practice Address - Country:US
Practice Address - Phone:954-842-6997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3369092163WH0200X, 163WS0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WS0200XNursing Service ProvidersRegistered NurseSchool