Provider Demographics
NPI:1750690871
Name:CLARK, ERIN COLLEEN (FNP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:COLLEEN
Last Name:CLARK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N BLANCHARD ST
Mailing Address - Street 2:SUITE 121
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-4503
Mailing Address - Country:US
Mailing Address - Phone:419-427-0809
Mailing Address - Fax:419-427-2840
Practice Address - Street 1:1800 N BLANCHARD ST
Practice Address - Street 2:SUITE 121
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-4503
Practice Address - Country:US
Practice Address - Phone:419-427-0809
Practice Address - Fax:419-427-2840
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000148368363L00000X
OHCOA15365NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner