Provider Demographics
NPI:1114689650
Name:CLARK, LORENA K C (ARNP-C)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:K C
Last Name:CLARK
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12210 CREEK PRESERVE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-6501
Mailing Address - Country:US
Mailing Address - Phone:646-256-3988
Mailing Address - Fax:
Practice Address - Street 1:12210 CREEK PRESERVE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-6501
Practice Address - Country:US
Practice Address - Phone:646-256-3988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9479417363LF0000X
FLF08210430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily