MEDICARE: MRS. JUDITH YVETTE CLARK APRN

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	363L00000X	Nurse Practitioner	APRN1442252	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y086K	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871884155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUDITH YVETTE CLARK APRN

Provider Business Mailing Address
First Line	:	7242 W COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-6749
Country	:	US
Telephone Number	:	407-296-2273
Fax Number	:	407-294-9740

Provider Business Practice Location Address
First Line	:	7242 W COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-6749
Country	:	US
Telephone Number	:	407-296-2273
Fax Number	:	407-294-9740

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

Provider Enumeration Date	:	04/21/2011
Last Update Date	:	08/13/2021

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