Angela G Clark
Clinic/Center, Developmental Disabilities in Plant City, FL. Individual provider (NPI-1).
NPI number1164072492
StatusActive
Last updated in NPPESSep 18, 2019
Details
- NPI
- 1164072492
- Entity type
- Individual (NPI-1)
- Name
- Angela G Clark
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Sep 18, 2019
- Last updated
- Sep 18, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD1600X | Clinic/Center, Developmental Disabilities | – | FL | Yes |
Practice location
4703 Horton RdPlant City, FL 33567-3625
Phone 813-808-9023
Mailing address
4703 Horton RdPlant City, FL 33567-3625
Phone 813-808-9023
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