Provider Demographics
NPI:1386256691
Name:MIDDLETON, CLINTON WAYNE (APRN FNP-C)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:WAYNE
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 POLLY DRUMMOND SHPG CTR STE 2
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-4861
Mailing Address - Country:US
Mailing Address - Phone:302-478-5707
Mailing Address - Fax:302-422-7315
Practice Address - Street 1:16 POLLY DRUMMOND SHPG CTR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-4861
Practice Address - Country:US
Practice Address - Phone:302-478-5707
Practice Address - Fax:302-422-7315
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0001437363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily