Provider Demographics
NPI:1548377492
Name:CLAY, MARLIE (ARNP)
Entity type:Individual
Prefix:
First Name:MARLIE
Middle Name:
Last Name:CLAY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 INTERNATIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-7392
Mailing Address - Country:US
Mailing Address - Phone:407-366-9800
Mailing Address - Fax:407-366-9283
Practice Address - Street 1:10701 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32821-7392
Practice Address - Country:US
Practice Address - Phone:407-366-9800
Practice Address - Fax:407-366-9283
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3052572363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE7395WMedicare PIN