Individual
JENNIFER M. CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N., FNP, PMHNP
Contact information
Practice address
500 DOYLE PARK DR STE G04, SANTA ROSA, CA 95405-4559
(707) 303-8349
(707) 303-2694
Mailing address
3114 CARVEL DR, SANTA ROSA, CA 95405-7062
(707) 757-3117
(707) 303-2694
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
740722
TX
363L00000X
Nurse Practitioner
Primary
NP12069
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
193487901
—
TX
01
—
8Y5099
BCBS
TX
01
—
P00622287
RR MEDICARE
TX
Enumeration date
01/18/2008
Last updated
05/08/2025
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