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Individual

STACEY ANN CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1447 MEDICAL PARK BLVD, #402, WELLINGTON, FL 33414
(561) 790-2600
(561) 790-1535
Mailing address
1447 MEDICAL PARK BLVD, #402, WELLINGTON, FL 33414
(561) 790-2600
(561) 790-1535

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME0070966
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
47177100
FL
Enumeration date
02/02/2006
Last updated
03/29/2011
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