Provider Demographics
NPI:1619077344
Name:CLARK, WILLIAM L JR (ARNP/CRNA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:L
Last Name:CLARK
Suffix:JR
Gender:M
Credentials:ARNP/CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10000 SW 52ND AVE
Mailing Address - Street 2:#20
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-4396
Mailing Address - Country:US
Mailing Address - Phone:352-262-2400
Mailing Address - Fax:
Practice Address - Street 1:10000 SW 52 AVE.
Practice Address - Street 2:#20
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-4006
Practice Address - Country:US
Practice Address - Phone:352-262-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9191829363LP2300X
FL9191829163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse