| NPI | 1326583196 |
|---|---|
| Former Name | TINA CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.020375) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV 118596) |
| Enumeration Date | 2017-01-03 |
| Last Update Date | 2024-08-29 |