CHARLES JOSEPH CLANCY (NPI# 1669410924) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669410924 |
| Entity Type | Individual |
| Full Name | CHARLES JOSEPH CLANCY |
| Credential | PA-C |
| Practice Address |
1005 Mar Walt Dr Immediate Care Department Fort Walton Beach FL 32547-6707 |
| Mailing Address |
1005 Mar Walt Drive Immediate Care Department Fort Walton Beach FL 32547-6796 |
| Practice Telephone | 8508638219 |
| Practice Fax Number | 8508638249 |
| Mailing Telephone | 8508638219 |
| Mailing Fax Number | 8508638249 |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2010-11-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | PA9103700 | FL | Allopathic & Osteopathic Physicians |
| Y | 363A00000X | Physician Assistant | PA9103700 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 292457900 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528088226 | Charles Clancy | Social Worker | 800 Zorn Ave, Louisville, KY 40206-1433 | 2006-07-19 |
| Street Address |
1005 MAR WALT DR IMMEDIATE CARE DEPARTMENT |
| City | FORT WALTON BEACH |
| State | FL |
| Zip Code | 32547-6707 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174517627 | Michael Andrew Johnson | Physician Assistant | 1005 Mar Walt Dr, Internal Medicine Department, Fort Walton Beach, FL 32547-6707 | 2005-09-09 |
| 1023658408 | Katelyn Elaine Dye | Nurse Practitioner | 1005 Mar Walt Dr, Fort Walton Beach, FL 32547-6707 | 2020-01-13 |
| 1467988220 | Katrina Pendleton Borner | Nurse Practitioner | 1005 Mar Walt Dr, Fort Walton Beach, FL 32547-6707 | 2017-05-11 |
| 1992067383 | Irina Viktorovna Smith | Pediatrics | 1005 Mar Walt Dr, Fort Walton Beach, FL 32547-6707 | 2012-06-12 |
| 1114242781 | Leslie Marie Anderson | Dietitian, Registered | 1005 Mar Walt Dr, Fort Walton Beach, FL 32547-6707 | 2010-04-07 |
| 1134267537 | White-wilson Medical Center, P.a. | Family Medicine | 1005 Mar Walt Dr, Fp Department, Fort Walton Beach, FL 32547-6707 | 2007-02-01 |
| 1518005917 | White-wilson Medical Center, P.a. | Pediatrics | 1005 Mar Walt Dr, Pediatric Department, Fort Walton Beach, FL 32547-6707 | 2007-02-01 |
| 1275519886 | Lawrence P King | Pediatrics | 1005 Mar Walt Dr, Pediatric Department, Fort Walton Beach, FL 32547-6707 | 2005-12-16 |
| 1336124098 | Harold Timothy Johnson | Physician Assistant | 1005 Mar Walt Dr, Family Medicine Department, Fort Walton Beach, FL 32547-6707 | 2005-12-14 |
| 1790760502 | Gilberto Luis Vigo | Internal Medicine | 1005 Mar Walt Dr, Internal Medicine Department, Fort Walton Beach, FL 32547-6707 | 2005-12-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255944955 | Theresa Ann Morvay | Behavior Technician | 419 Racetrack Rd Ne, Fort Walton Beach, FL 32547 | 2020-08-24 |
| 1588295422 | Emily Ann Glossop | Nurse Practitioner | 930 Mar Walt Drive C, Fort Walton Beach, FL 32547 | 2020-01-29 |
| 1225669443 | Elizabeth Rogers Nagengast | Physician Assistant | 930 Mar Walt Drive, Unit C, Fort Walton Beach, FL 32547 | 2020-01-27 |
| 1497254791 | Carmen Alston | Nurse Practitioner | 930 Mar Walt Dr C, Fort Walton Beach, FL 32547 | 2018-02-02 |
| 1871004960 | Center for Neuropsychological Services Cns | Clinical Neuropsychologist | 1817 Lewis Turner Blvd, Fort Walton Beach, FL 32547 | 2017-10-17 |
| 1194235648 | Robin Wray | Speech-Language Pathologist | 930 Mar Walt Dr D, Fort Walton Beach, FL 32547 | 2017-10-10 |
| 1285007989 | Dynamic Pain & Wellness Pllc | Pain Medicine | 930 Marwalt Drive, Suite B and C, Fort Walton Beach, FL 32547 | 2015-11-04 |
| 1013392810 | Terry Abbott | Social Worker | 648 Overbrook Dr, Fort Walton Beach, FL 32547 | 2015-07-22 |
| 1083024673 | Emily Lohr | Physical Therapy Assistant | 2000 Principle Ln, Ft. Walton Beach, FL 32547 | 2014-05-05 |
| 1831526102 | Laurie Ann Schweppe | Nurse Practitioner | 1005 Mar Walt Drivve, Snf Hospitalist Department, Fort Walton Beach, FL 32547 | 2013-10-02 |
| Find all providers in zip 32547 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225669443 | Elizabeth Rogers Nagengast | Physician Assistant | 930 Mar Walt Drive, Unit C, Fort Walton Beach, FL 32547 | 2020-01-27 |
| 1427525195 | Katelyn Robson | Physician Assistant | 320 Racetrack Rd Nw Ste 100c, Fort Walton Beach, FL 32547-1796 | 2018-10-31 |
| 1003112715 | Danielle Horton | Physician Assistant | 914 Mar Walt Dr Ste A, Fort Walton Beach, FL 32547-6706 | 2011-01-28 |
| 1003902446 | Jill Virginia Ash | Physician Assistant | 339 Racetrack Rd, Suite 2, Fort Walton Beach, FL 32547 | 2006-10-05 |
| 1538271226 | Katia V. Murphy-blount | Physician Assistant | 1032 Mar Walt Drive Suite 230, Northwest Florida Heart Institute, Fort Walton Beach, FL 32547 | 2006-08-31 |
| 1174517627 | Michael Andrew Johnson | Physician Assistant | 1005 Mar Walt Dr, Internal Medicine Department, Fort Walton Beach, FL 32547-6707 | 2005-09-09 |
| 1154953743 | John Loftis | Physician Assistant | 930 Mar Walt Drive, Unit C, Fort Walton Beach, FL 32547-6706 | 2020-02-11 |
| 1689219446 | Jordan Zemis Miles | Physician Assistant | 137 Hospital Dr Ne, Fort Walton Beach, FL 32548-5063 | 2019-11-15 |
| 1144797366 | Sara Rothe | Physician Assistant | 514 Mary Esther Cut Off Nw, Fort Walton Beach, FL 32548-4047 | 2018-10-25 |
| 1841765351 | Mallory Hope Maddox | Physician Assistant | 1005 Mar Walt Drive, Immediate Care Department, Fort Walton Beach, FL 32547-6707 | 2018-10-11 |
| Find all providers in FORT WALTON BEACH | ||||
| City | FORT WALTON BEACH |
| Zip Code | 32547 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.