Provider Demographics
NPI:1154961811
Name:MCCLARNON, DEBRALYN M
Entity type:Individual
Prefix:
First Name:DEBRALYN
Middle Name:M
Last Name:MCCLARNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14745 KEY LIME BLVD
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-5279
Mailing Address - Country:US
Mailing Address - Phone:561-693-9396
Mailing Address - Fax:
Practice Address - Street 1:217 W AVENUE A
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-3019
Practice Address - Country:US
Practice Address - Phone:561-992-4888
Practice Address - Fax:561-992-4488
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006677207Q00000X
TXAP142591363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty