Provider Demographics
NPI:1851945539
Name:CLARK, SARAH JEAN (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JEAN
Last Name:CLARK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1811 BLANDING BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-4935
Mailing Address - Country:US
Mailing Address - Phone:904-203-2852
Mailing Address - Fax:904-406-0654
Practice Address - Street 1:5915 NORMANDY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-6200
Practice Address - Country:US
Practice Address - Phone:904-379-8085
Practice Address - Fax:904-619-8042
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61111335363A00000X
FLPA9116056363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant