Provider Demographics
NPI:1518700459
Name:CLARK, SARAH MATTHES
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:MATTHES
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:BETH
Other - Last Name:MATTHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PSC 819 BOX 18
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09645-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:APARTADO DE CORREOS 33
Practice Address - Street 2:
Practice Address - City:ROTA
Practice Address - State:CADIZ
Practice Address - Zip Code:11530
Practice Address - Country:ES
Practice Address - Phone:727-385-5648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAF06240555363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily