MEDICARE: JOSHUA NATHANIEL 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	363A00000X	Physician Assistant	PA9119484	FL

General Provider Information

NPI Number	:	1639263684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA NATHANIEL CLARK

Provider Business Mailing Address
First Line	:	1882 CR 431A
Second Line	:
City	:	LAKE PANASOFFKEE
State	:	FL
Zip	:	33538-4620
Country	:	US
Telephone Number	:	609-408-3916
Fax Number	:

Provider Business Practice Location Address
First Line	:	1882 CR 431A
Second Line	:
City	:	LAKE PANASOFFKEE
State	:	FL
Zip	:	33538-4620
Country	:	US
Telephone Number	:	609-408-3916
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	11/25/2024

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Directions to “ JOSHUA NATHANIEL CLARK ” Practice Location

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