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Individual
TIFFANY G CLARK
Active
Individual
TIFFANY G CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024170609
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548508203
—
VA
Enumeration date
01/30/2013
Last updated
05/20/2024
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