Individual
GINA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
U
Contact information
Practice address
1650 COCHRANE CIR, FORT CARSON, CO 80913-4613
(719) 524-0016
Mailing address
6445 WILSON RD, COLORADO SPRINGS, CO 80919-3524
(720) 935-3575
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F02250032
CO
Other
Enumeration date
02/11/2025
Last updated
02/11/2025
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