Basic Information
Provider Information
NPI: 1619482817
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AKE
FirstName: CLAIRE
MiddleName: ELIZABETH
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 13612 S VILLAGE DR APT 102
Address2:  
City: TAMPA
State: FL
PostalCode: 336188393
CountryCode: US
TelephoneNumber: 8284236059
FaxNumber:  
Practice Location
Address1: 2727 W DR MLK BLVD STE 310
Address2:  
City: TAMPA
State: FL
PostalCode: 336076063
CountryCode: US
TelephoneNumber: 8133507244
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/11/2017
LastUpdateDate: 02/14/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XARNP9355618FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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