Individual
CANDACE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17008 SW 39TH ST, MIRAMAR, FL 33027-4614
(786) 232-2902
Mailing address
2114 N FLAMINGO RD, #169, PEMBROKE PINES, FL 33028-3501
(786) 232-2902
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016651300
—
FL
Enumeration date
06/21/2016
Last updated
06/21/2016
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