Provider Demographics
NPI:1760076053
Name:CLARK, JANAE ALISE (APRN)
Entity Type:Individual
Prefix:
First Name:JANAE
Middle Name:ALISE
Last Name:CLARK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JANAE
Other - Middle Name:ALISE
Other - Last Name:HERZOG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5810 CANDYTUFT PL
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-2646
Mailing Address - Country:US
Mailing Address - Phone:813-435-3897
Mailing Address - Fax:
Practice Address - Street 1:5810 CANDYTUFT PL
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-2646
Practice Address - Country:US
Practice Address - Phone:813-435-3897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11011659363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care