Most Relevant Information
Provider Data
| NPI Number: | 1003671629 |
| Provider Name: | DIANA ISABEL CLAVIJO |
| Entity Type: | Individual |
| Taxonomy Code: | 363LP2300X |
| Specialty: | Nurse Practitioner |
| License Number: | 11030622 |
Most Important Dates
| Enumeration Date: | 02/14/2024 |
| Last Updated: | 02/14/2024 |
Provider Practice Location
7549 NW GREENSPRING ST
PORT ST LUCIE
FL
349873050
Practice Location Phone/Fax
| Phone: | 9542745691 |
| Fax: |
Provider Mailing Location
7549 NW GREENSPRING ST
PORT ST LUCIE
FL
349873050
Provider Mailing Phone/Fax
| Phone: | 9542745691 |
| Fax: |