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Individual
BRIANNA M CLARK
Active
Individual
BRIANNA M CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
MA065551
PA
363AS0400X
Surgical Physician Assistant
Primary
MA065551
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16916047
CAQH
—
Enumeration date
06/17/2024
Last updated
09/23/2026
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