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Organization

NATURE COAST PSYCHIATRY PLLC

Active
Other names
Dr Eilis Clark MD
Organization subpart
No

Provider details

NPI number
Authorized official
DR. EILIS CLARK MD (MGRM)
(352) 631-7460
Entity
Organization

Contact information

Practice address
210 S SALISBURY TER, LECANTO, FL 34461-5104
(352) 631-7460
Mailing address
210 S SALISBURY TER, LECANTO, FL 34461-5104

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2084P0800X
Psychiatry Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
011682400
FL
Enumeration date
06/28/2019
Last updated
01/04/2020
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