Individual
MYIA MCCLOUD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
22421 SE 59TH PL, HAWTHORNE, FL 32640-3616
(904) 640-1121
Mailing address
22421 SE 59TH PL, HAWTHORNE, FL 32640-3616
(706) 680-9103
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN9526308
FL
164W00000X
Licensed Practical Nurse
PN5197555
FL
Other
Enumeration date
02/28/2018
Last updated
03/20/2023
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