Individual
JEREMY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
810 SAINT VINCENTS DR, BIRMINGHAM, AL 35205-1601
(904) 372-3943
(904) 212-1618
Mailing address
7751 BELFORT PKWY STE 120, JACKSONVILLE, FL 32256-6921
(904) 372-3943
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-178487
AL
Other
Enumeration date
08/14/2023
Last updated
10/02/2024
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