Provider Demographics
NPI:1144043910
Name:CLARK, JENNA MARIE (MSN FNP-C)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:CLARK
Suffix:
Gender:F
Credentials:MSN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 WESTHAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-2368
Mailing Address - Country:US
Mailing Address - Phone:774-445-9099
Mailing Address - Fax:
Practice Address - Street 1:1201 S CARSON ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-5225
Practice Address - Country:US
Practice Address - Phone:775-445-7330
Practice Address - Fax:775-841-1139
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV884347363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner