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General NPI Number Information
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NPI Number | 1164921854
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Entity Type | Individual
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Provider Name | SARAH SHIVERS CLARK NP-C
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Gender | Female
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Dates
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Enumeration Date | 02/07/2018
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Last Update Date | 03/13/2018
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Provider Practice Location Address
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Address Line | 1717 N E ST STE 239
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City | PENSACOLA
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State | FL
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Zip | 32501-6390
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Country | US
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Telephone | 850-432-3467
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Fax | 850-434-2308
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Provider Business Mailing Address
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Address Line | 3313 KINGS WAY
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City | PENSACOLA
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State | FL
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Zip | 32504-4809
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Country | US
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Telephone | 601-842-4291
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9376525
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License Number State | FL
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