Provider Demographics
NPI:1356300347
Name:STEPHENSON CLAYTON, CAROL W (DNS, CPNP)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:W
Last Name:STEPHENSON CLAYTON
Suffix:
Gender:F
Credentials:DNS, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3546
Mailing Address - Country:US
Mailing Address - Phone:407-905-8827
Mailing Address - Fax:407-905-8998
Practice Address - Street 1:618 S FOREST AVE
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5338
Practice Address - Country:US
Practice Address - Phone:407-905-8827
Practice Address - Fax:407-886-3822
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1990612363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL034703500Medicaid
FL380124OtherWELLCARE
FL01134624OtherAMERIGROUP