Individual
TINA MARIE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20812 E WATSON LN, OTIS ORCHARDS, WA 99027-8234
(509) 850-6519
Mailing address
20812 E WATSON LN, OTIS ORCHARDS, WA 99027-8234
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
RN00146844
WA
363L00000X
Nurse Practitioner
ARNP.AP.70120514-NP
WA
Other
Enumeration date
09/22/2025
Last updated
07/02/2026
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