Provider Demographics
NPI:1548514367
Name:CLARK, ELIZABETH MAURINE (APRN, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:MAURINE
Last Name:CLARK
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:MAURINE
Other - Last Name:ISKANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-BC
Mailing Address - Street 1:6301 GASTON AVE STE 100W
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-6273
Mailing Address - Country:US
Mailing Address - Phone:214-827-3610
Mailing Address - Fax:214-821-4017
Practice Address - Street 1:6301 GASTON AVE STE 100W
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214
Practice Address - Country:US
Practice Address - Phone:214-827-3610
Practice Address - Fax:214-821-4017
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX743837363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily