Individual
MS. JENNIFER LYNN PEACOCK CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
173 MESEROLE AVE APT 2L, BROOKLYN, NY 11222-2424
(646) 256-2104
Mailing address
173 MESEROLE AVE APT 2L, BROOKLYN, NY 11222-2424
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
561419
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
308588
NY
Other
Enumeration date
12/20/2017
Last updated
03/03/2021
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