Provider Demographics
NPI:1255345047
Name:CLARK, MARY JANET (ARNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JANET
Last Name:CLARK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JANET
Other - Last Name:STELZMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2825 SE 45TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-7225
Mailing Address - Country:US
Mailing Address - Phone:352-867-7067
Mailing Address - Fax:352-867-8363
Practice Address - Street 1:1601 SW ARCHER RD
Practice Address - Street 2:#118
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1135
Practice Address - Country:US
Practice Address - Phone:352-376-1611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1279432363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY8814OtherBS PROV
FLY8814OtherBS PROV
FLY8814-ZMedicare ID - Type Unspecified