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Individual

BIANCA CLERMONT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
5802 N 30TH ST, TAMPA, FL 33610-1469
(813) 236-5100
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
(813) 974-2201
(813) 974-2812

Taxonomy

Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
11001853
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
105452900
FL
01
HRJBN
BLUE CROSS BLUE SHIELD
FL
01
L7264
MEDICARE
FL
Enumeration date
03/15/2019
Last updated
10/26/2020
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