Provider Demographics
NPI:1972609436
Name:CLARK, PATRICK TIMOTHY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:TIMOTHY
Last Name:CLARK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 US HIGHWAY 27 N
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-1333
Mailing Address - Country:US
Mailing Address - Phone:863-314-0020
Mailing Address - Fax:863-381-0024
Practice Address - Street 1:4020 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1333
Practice Address - Country:US
Practice Address - Phone:863-314-0020
Practice Address - Fax:863-381-0024
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 2384363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical