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Individual

TIFFANY RENEE CLARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
SMALL BUSINESS OWNER

Contact information

Practice address
6632 OAKS EDGE DR, ZACHARY, LA 70791-3259
(225) 268-5939
Mailing address
PO BOX 34, ZACHARY, LA 70791-0034
(225) 268-5939

Taxonomy

Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary

Other

Enumeration date
07/09/2019
Last updated
07/09/2019
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