MEDICARE: MS. NANCY DEBORAH CLARK A.P.

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	171100000X	Acupuncturist	891	FL

General Provider Information

NPI Number	:	1861517716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY DEBORAH CLARK A.P.

Provider Business Mailing Address
First Line	:	2134 NE 123RD ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2902
Country	:	US
Telephone Number	:	305-981-7958
Fax Number	:	305-981-7961

Provider Business Practice Location Address
First Line	:	2134 NE 123RD ST
Second Line	:
City	:	NORTH MIAMI
State	:	FL
Zip	:	33181-2902
Country	:	US
Telephone Number	:	305-981-7958
Fax Number	:	305-981-7961

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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