Individual
THERESA A CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN/LDN, CSP
Contact information
Practice address
615 E PRINCETON ST STE 104, ORLANDO, FL 32803-1435
(407) 303-6920
Mailing address
615 E PRINCETON ST STE 104, ORLANDO, FL 32803-1435
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
10481
FL
Other
Enumeration date
10/08/2025
Last updated
10/08/2025
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