Provider Demographics
NPI:1821383431
Name:CLARK, BRITTANY (MD)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MICCOSUKEE RD
Mailing Address - Street 2:FSU/TMH INTERNAL MEDICINE RESIDENCY PROGRAM
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5054
Mailing Address - Country:US
Mailing Address - Phone:850-431-8250
Mailing Address - Fax:850-431-8251
Practice Address - Street 1:1300 MICCOSUKEE RD
Practice Address - Street 2:FSU/TMH INTERNAL MEDICINE RESIDENCY PROGRAM
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5054
Practice Address - Country:US
Practice Address - Phone:850-431-8250
Practice Address - Fax:850-431-8251
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME120445207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNONEMedicaid