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General NPI Number Information
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NPI Number | 1609580604
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Entity Type | Individual
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Provider Name | JOSHUA DANE CLARKE CRNP
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Gender | Male
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Dates
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Enumeration Date | 01/13/2023
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Last Update Date | 01/13/2023
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Provider Practice Location Address
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Address Line | 1097 INDUSTRIAL PKWY
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City | SARALAND
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State | AL
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Zip | 36571-3744
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Country | US
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Telephone | 251-375-2270
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Fax |
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Provider Business Mailing Address
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Address Line | 9478 SIR BRUTUS CT
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City | MOBILE
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State | AL
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Zip | 36695-6950
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Country | US
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Telephone | 251-490-1838
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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 | 1-133045
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License Number State | AL
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