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Individual
MICHELLE E CLARK
Active
Individual
MICHELLE E CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN9291822
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006113900
—
FL
05
—
02456100
—
FL
01
—
GI608Z
MEDICARE
FL
01
—
Y0C94
BCBS
FL
Enumeration date
07/17/2012
Last updated
06/08/2023
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