Healthcare Provider Details

I. General information

NPI: 1982200010
Provider Name (Legal Business Name): RACHEL TERESA CLARK DNP, APN, AG-ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 HADDON AVE, CC2 UNIT
CAMDEN NJ
08103
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-668-8818
  • Fax: 856-668-8490
Mailing address:
  • Phone: 856-355-0340
  • Fax: 856-355-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26NJ01083700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number26NJ01083700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: