Individual
THERESA CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
1 HEALTHY WAY, OCEANSIDE, NY 11572-1551
(516) 632-4998
(516) 747-7947
Mailing address
63 TAFT AVE, LYNBROOK, NY 11563-1428
(929) 312-5809
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
309852
NY
Other
Enumeration date
12/01/2020
Last updated
12/01/2020
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