Provider Demographics
NPI:1932384344
Name:CLAYTON, ANDREA KATRINA (PROVIDER)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:KATRINA
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 NE 15TH ST APT 107
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-2061
Mailing Address - Country:US
Mailing Address - Phone:352-213-5624
Mailing Address - Fax:352-451-4914
Practice Address - Street 1:4121 NE 15TH ST APT 107
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-2061
Practice Address - Country:US
Practice Address - Phone:352-213-5624
Practice Address - Fax:352-451-4914
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL39971191251S00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39971191OtherAGENCY FOR HEALTH CARE ADMINISTRATION
FL692994096Medicaid