Provider Demographics
NPI:1053402974
Name:CLEMENTS, PAUL R (PHD, ARNP-BC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:PHD, ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 GULF BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLEAIR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33786-3500
Mailing Address - Country:US
Mailing Address - Phone:727-641-5507
Mailing Address - Fax:866-533-1384
Practice Address - Street 1:2605 GULF BLVD
Practice Address - Street 2:
Practice Address - City:BELLEAIR BEACH
Practice Address - State:FL
Practice Address - Zip Code:33786-3500
Practice Address - Country:US
Practice Address - Phone:727-641-5507
Practice Address - Fax:866-533-1384
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9231546363LP0808X
FLARNP923363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAS396Medicare PIN