Provider Demographics
NPI:1952491797
Name:CLARK, LINDA (APRN-BC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:CLARK, NP, NURSING INC.
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN-BC
Mailing Address - Street 1:1950 PORT LOCKSLEIGH PL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-6616
Mailing Address - Country:US
Mailing Address - Phone:951-201-7708
Mailing Address - Fax:949-520-7329
Practice Address - Street 1:4630 CAMPUS DR STE 112
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1804
Practice Address - Country:US
Practice Address - Phone:951-201-7708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP16640163WG0000X, 207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine