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General NPI Number Information
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NPI Number | 1780051847
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Entity Type | Individual
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Provider Name | KAREN CLARK R.N.
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Gender | Female
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Dates
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Enumeration Date | 08/25/2015
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Last Update Date | 08/25/2015
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Provider Practice Location Address
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Address Line | 120 INTERNATIONAL PKWY SUITE 220
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City | LAKE MARY
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State | FL
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Zip | 32746-5031
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Country | US
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Telephone | 800-432-8421
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Fax | 407-333-8928
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Provider Business Mailing Address
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Address Line | PO BOX 952679
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City | LAKE MARY
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State | FL
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Zip | 32795-2679
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Country | US
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Telephone | 800-432-8421
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Fax | 407-333-8928
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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 | 305S00000X
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Taxonomy Name | Point of Service
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License Number | RN9232718
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 28066933A
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License Number State | IN
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