Organization
SANDRA WEAVER CLARK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA WEAVER CLARK (CASE MANAGER)
(321) 946-9866
Entity
Organization
Contact information
Practice address
602 GEORGETOWN DR APT B, CASSELBERRY, FL 32707-6132
(321) 946-9866
Mailing address
602 GEORGETOWN DR APT B, CASSELBERRY, FL 32707-6132
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009081000
—
FL
Enumeration date
11/02/2015
Last updated
11/02/2015
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