MEDICARE: TYRONDA CLARK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	4704334945	MI

General Provider Information

NPI Number	:	1164363776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYRONDA CLARK

Provider Business Mailing Address
First Line	:	1237 TYLER CT
Second Line	:
City	:	HASLET
State	:	TX
Zip	:	76052-3092
Country	:	US
Telephone Number	:	313-743-4254
Fax Number	:

Provider Business Practice Location Address
First Line	:	1237 TYLER CT
Second Line	:
City	:	HASLET
State	:	TX
Zip	:	76052-3092
Country	:	US
Telephone Number	:	313-743-4254
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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Directions to “ TYRONDA CLARK ” Practice Location

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