Individual
CAROLYN B CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1217 S EAST AVE STE 104, SARASOTA, FL 34239-2350
(941) 365-0433
(941) 954-2064
Mailing address
PO BOX 5699, SARASOTA, FL 34277-5699
(941) 365-0433
(941) 954-2064
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP1360702
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
753072541
TAX ID
FL
Enumeration date
09/23/2005
Last updated
12/19/2019
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