Individual
JOHNEISHA DENISE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3333 W 20TH ST, JACKSONVILLE, FL 32254-1703
(904) 695-9145
Mailing address
3333 W 20TH ST, JACKSONVILLE, FL 32254-1703
(904) 695-9145
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN11004035
FL
Other
Enumeration date
08/26/2019
Last updated
02/11/2022
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