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NPI Code Detail

MEDICARE: PATRICIA ANN CLARK APRN, FNP-C

MEDICARE: PATRICIA ANN CLARK APRN, FNP-C
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
1363LF0000XFamily Nurse Practitioner3-002864AL
2363LF0000XFamily Nurse Practitioner0000022832TN

General Provider Information

NPI Number : 1619495819
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA ANN CLARK APRN, FNP-C
Provider Business Mailing Address
First Line : PO BOX 211699
Second Line :
City : EAGAN
State : MN
Zip : 55121-3699
Country : US
Telephone Number : 866-849-0692
Fax Number : 888-973-8821
Provider Business Practice Location Address
First Line : 3200 W END AVE
Second Line :
City : NASHVILLE
State : TN
Zip : 37203-1330
Country : US
Telephone Number : 866-849-0692
Fax Number : 888-973-8821
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2017
Last Update Date : 03/03/2026

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