Provider Demographics
NPI:1417271834
Name:CLARKE, DEBRA (AP # 1697)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:AP # 1697
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 E LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3220
Mailing Address - Country:US
Mailing Address - Phone:407-878-3813
Mailing Address - Fax:407-878-3815
Practice Address - Street 1:122 E LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3220
Practice Address - Country:US
Practice Address - Phone:407-878-3813
Practice Address - Fax:407-878-3815
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP#1697171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist