Provider Demographics
NPI:1083079602
Name:BROWN-CLARK, ROSA LEE
Entity Type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:LEE
Last Name:BROWN-CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 CODY DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4214
Mailing Address - Country:US
Mailing Address - Phone:904-699-2601
Mailing Address - Fax:
Practice Address - Street 1:453 CODY DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4214
Practice Address - Country:US
Practice Address - Phone:904-699-2601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-26
Last Update Date:2015-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider
No376J00000XNursing Service Related ProvidersHomemaker