Provider Demographics
NPI:1912996232
Name:CLAYTON, MARILYN BETH (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:BETH
Last Name:CLAYTON
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 1:1925 HARBOR POINT DR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-2835
Mailing Address - Country:US
Mailing Address - Phone:321-459-9948
Mailing Address - Fax:321-783-1999
Practice Address - Street 1:503 N ORLANDO AVE
Practice Address - Street 2:#103
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3171
Practice Address - Country:US
Practice Address - Phone:321-783-2722
Practice Address - Fax:321-783-1999
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1989452363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR98674Medicare UPIN
FLY4077ZMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #
FLK1942Medicare ID - Type UnspecifiedGROUP PROVIDER#