Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 9343252 | FL |
NPI | 1023510708 |
---|---|
Provider Name | Erica Clark |
First Address | Homosassa, FL 34446-5005 |
Second Address | Homosassa, FL 34446-5005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2018 |
Last Update Date | 08/03/2018 |