Basic Information
| Provider Information | |||||||||
| NPI: | 1376830984 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VERNA | ||||||||
| FirstName: | CLAIRE | ||||||||
| MiddleName: | MICHELE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WILLIAM | ||||||||
| OtherFirstName: | CLAIRE | ||||||||
| OtherMiddleName: | MICHELE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8773 PERIMETER PARK CT | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322161165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044933390 | ||||||||
| FaxNumber: | 9044933395 | ||||||||
| Practice Location | |||||||||
| Address1: | 8773 PERIMETER PARK CT | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322161165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9044933390 | ||||||||
| FaxNumber: | 9044933395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2011 | ||||||||
| LastUpdateDate: | 08/04/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME120594 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | ME120594 | FL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 1025610 | 01 | FL | WELLCARE | OTHER | 2610299-00 | 01 | FL | FL MEDICAID - GROUP | OTHER | 7373650 | 01 | FL | CIGNA | OTHER | PO1555677 | 01 | FL | RR MEDICARE | OTHER | 0160942-00 | 05 | FL | MEDICAID | 45681 | 01 | FL | MEDICARE - GROUP | OTHER | 45681 | 01 | FL | FLORIDA BLUE - GROUP | OTHER | CH6711 | 01 | FL | RR MCR - GROUP | OTHER | 375893 | 01 | FL | AVMED | OTHER |