Provider Demographics
NPI:1912297466
Name:CLAPP, BEVERLY (MT)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:CLAPP
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3123 NW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-2760
Mailing Address - Country:US
Mailing Address - Phone:352-338-9293
Mailing Address - Fax:352-338-9293
Practice Address - Street 1:3123 NW 27TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-2760
Practice Address - Country:US
Practice Address - Phone:352-338-9293
Practice Address - Fax:352-338-9293
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-17
Last Update Date:2011-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSU 31566246QL0900X
AL107058246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
No246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management