Individual
GABRIELA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
11050 CRABAPPLE ROAD, BLDG. A, SUITE 104-B, ROSWELL, GA 30075
(770) 645-0017
(770) 645-0224
Mailing address
11050 CRABAPPLE ROAD, BLDG. A, SUITE 104-B, ROSWELL, GA 30075
(770) 645-0017
(770) 645-0224
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
RN294112
GA
363LF0000X
Family Nurse Practitioner
Primary
RN294112
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN294112
GEORGIA BOARD OF NURSING
GA
Enumeration date
09/21/2023
Last updated
09/21/2023
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