Provider Demographics
NPI:1023083847
Name:MCCLURE-DRABICK, DENISE SHARON (CRNA, ARNP,BA ,RN)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:SHARON
Last Name:MCCLURE-DRABICK
Suffix:
Gender:F
Credentials:CRNA, ARNP,BA ,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 LAKE PARK DR
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-1942
Mailing Address - Country:US
Mailing Address - Phone:904-321-1630
Mailing Address - Fax:
Practice Address - Street 1:1709 LAKE PARK DR
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-1942
Practice Address - Country:US
Practice Address - Phone:904-557-8101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2017-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-118994 NA-03139367500000X
NC213978367500000X
GA209729367500000X
FL9187995367500000X
OR201042814367500000X
TN178000367500000X
CARN-790152/CRNA-4035367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG3280OtherBC/BS OF FLORIDA #G3280
FL309088400Medicaid
GA771334230Medicaid
FLE7453AMedicare PIN