Provider Demographics
NPI:1497429948
Name:CLARK, TERESA ANN (FNP-C)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:CLARK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 COUNTRYSIDE BLVD N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-4928
Mailing Address - Country:US
Mailing Address - Phone:727-784-2848
Mailing Address - Fax:
Practice Address - Street 1:3825 COUNTRYSIDE BLVD N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-4928
Practice Address - Country:US
Practice Address - Phone:727-784-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-06
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348054363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily