Individual
DR. ELIZABETH A CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4400 E HIGHWAY 20, STE 410, NICEVILLE, FL 32578-8779
(850) 654-3376
(850) 654-3320
Mailing address
12469 EMERALD COAST PKWY W, STE 101, MIRAMAR BEACH, FL 32550-8305
(850) 654-3376
(850) 654-3320
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME66298
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
252552600
—
FL
Enumeration date
12/13/2005
Last updated
01/15/2013
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