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NPI Code Detail

MEDICARE: TORI CLARK FNP-BC

MEDICARE: TORI CLARK FNP-BC
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
1363L00000XNurse Practitioner209034149IL

General Provider Information

NPI Number : 1598624629
Entity Type Code : Individual
Provider Name (Legal Business Name) : TORI CLARK FNP-BC
Provider Business Mailing Address
First Line : 503 N HUDSON ST
Second Line :
City : STOCKTON
State : IL
Zip : 61085-1223
Country : US
Telephone Number : 815-599-6000
Fax Number :
Provider Business Practice Location Address
First Line : 1045 W STEPHENSON ST
Second Line :
City : FREEPORT
State : IL
Zip : 61032-4864
Country : US
Telephone Number : 815-599-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2026
Last Update Date : 01/15/2026

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Directions to “ TORI CLARK FNP-BC” Practice Location

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