Individual
VIVETTE CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1591 SW SILVER LN, PORT ST LUCIE, FL 34953-4116
(772) 336-4729
Mailing address
1591 SW SILVER LN, PORT ST LUCIE, FL 34953-4116
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN 979531
FL
Other
Enumeration date
11/20/2007
Last updated
11/20/2007
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