Provider Demographics
NPI:1316299431
Name:CLIFFORD, CELESTINE
Entity type:Individual
Prefix:
First Name:CELESTINE
Middle Name:
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:
Other - Last Name:CLIFFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1330 RAINTREE BND
Mailing Address - Street 2:APT. 108
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-8476
Mailing Address - Country:US
Mailing Address - Phone:352-255-6458
Mailing Address - Fax:352-410-6118
Practice Address - Street 1:1153 10TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2872
Practice Address - Country:US
Practice Address - Phone:352-255-6458
Practice Address - Fax:352-410-6118
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC416100648050OtherDRIVERS LICENSE