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General NPI Number Information
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NPI Number | 1912363946
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Entity Type | Individual
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Provider Name | KAILEY CLARK ARNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/06/2016
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Last Update Date | 07/21/2024
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Provider Practice Location Address
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Address Line | 4612 N HABANA AVE FL 2
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City | TAMPA
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State | FL
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Zip | 33614-7101
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Country | US
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Telephone | 813-875-9000
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Fax | 813-874-3278
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Provider Business Mailing Address
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Address Line | 4612 N HABANA AVE FL 2
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City | TAMPA
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State | FL
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Zip | 33614-7101
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Country | US
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Telephone | 813-875-9000
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Fax | 813-874-3278
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP9320963
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN9320963
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License Number State | FL
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