Provider Demographics
NPI:1164921854
Name:CLARK, SARAH SHIVERS (NP-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:SHIVERS
Last Name:CLARK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 KINGS WAY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-4809
Mailing Address - Country:US
Mailing Address - Phone:601-842-4291
Mailing Address - Fax:
Practice Address - Street 1:1717 N E ST STE 239
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6390
Practice Address - Country:US
Practice Address - Phone:850-432-3467
Practice Address - Fax:850-434-2308
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9376525363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily