Individual
DEIRDRA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP (NP-C)
Contact information
Practice address
5007 #2 VICTORY BLVD., TABB, VA 23693-5606
(757) 234-7987
Mailing address
2620 ELM HILL PIKE, NASHVILLE, TN 37214-3108
(615) 425-4200
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024172570
VA
Other
Enumeration date
09/15/2015
Last updated
09/15/2015
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