Provider Demographics
NPI:1891577391
Name:MCCLOUD, MIA (ARNP)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:MCCLOUD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 NW 8TH AVE STE B81043
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-5011
Mailing Address - Country:US
Mailing Address - Phone:904-203-9610
Mailing Address - Fax:
Practice Address - Street 1:5964 US HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32060-8694
Practice Address - Country:US
Practice Address - Phone:386-963-6530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11029272363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health