Clancy, Charles Joseph

Clancy, Charles Joseph is an individual health care provider with primary practice located at 1005 Mar Walt Dr Immediate Care Department, Fort Walton Beach FL 32547-6707. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Allopathic & Osteopathic Physicians / Emergency Medicine. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Clancy, Charles Joseph can be contacted via phone (850) 863-8219.

Contact Information

Primary practice address
1005 Mar Walt Dr Immediate Care Department Fort Walton Beach FL 32547-6707
Phone: (850) 863-8219
Fax: (850) 863-8249
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA9103700 Florida
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X PA9103700 Florida

Profile Details

NPI number 1669410924
LBN Legal business name Clancy, Charles Joseph
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 2nd, 2006
Last updated Nov 15th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669410924 NPPES
Florida MEDICAID 292457900

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