Provider Demographics
NPI:1881868107
Name:CLARK-WHITLOCK, ANN L (ARNP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:L
Last Name:CLARK-WHITLOCK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 41ST AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-4527
Mailing Address - Country:US
Mailing Address - Phone:727-528-1066
Mailing Address - Fax:727-528-1066
Practice Address - Street 1:205 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3109
Practice Address - Country:US
Practice Address - Phone:727-824-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9236081363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD62156OtherPRESCRIBER NUMBER