Provider Demographics
NPI:1275999880
Name:CLARKE, TANYA (MD)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2589 N STATE ROAD 7 # KIN5100
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-2778
Mailing Address - Country:US
Mailing Address - Phone:954-714-1264
Mailing Address - Fax:954-320-7142
Practice Address - Street 1:2589 N STATE ROAD 7 # KIN5100
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-2778
Practice Address - Country:US
Practice Address - Phone:954-714-1264
Practice Address - Fax:954-320-7142
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME126173207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine