Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | APRN9294102 | FL |
NPI | 1295107035 |
---|---|
Provider Name | Miss Rebecca Uma Clark |
First Address | Melbourne, FL 32901-3111 |
Second Address | Melbourne, FL 32901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2015 |
Last Update Date | 17/04/2019 |