Individual
MRS. JENNIFER M CLARKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH LMT
Contact information
Practice address
1304 DESOTO AVE, SUITE 202, TAMPA, FL 33606-3138
(813) 253-0868
Mailing address
1304 DESOTO AVE, SUITE 202, TAMPA, FL 33606-3138
(813) 253-0868
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MA12566
FL
Other
Enumeration date
06/10/2008
Last updated
06/10/2008
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