Individual
MS. TATYANA CLARKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
1121 W TIOGA ST, PHILADELPHIA, PA 19140-4203
(267) 454-5155
Mailing address
1121 W TIOGA ST, PHILADELPHIA, PA 19140-4203
(267) 454-5155
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN786192
PA
Other
Enumeration date
09/24/2025
Last updated
09/24/2025
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