Individual
ROBERT CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
26347 LAKE LINDSEY RD, BROOKSVILLE, FL 34601-4304
(352) 650-3825
(352) 799-5200
Mailing address
PO BOX 171, ISTACHATTA, FL 34636-0171
(352) 650-3825
(352) 799-5200
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN1295281
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PN1295281
LPN
FL
Enumeration date
04/23/2007
Last updated
07/08/2007
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