Provider Demographics
NPI:1730577016
Name:CLARK, MARIBETH COLLARD (CRNP)
Entity type:Individual
Prefix:MRS
First Name:MARIBETH
Middle Name:COLLARD
Last Name:CLARK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MARIBETH
Other - Middle Name:KATHLEEN
Other - Last Name:COLLARD-CLARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:6801 AIRPORT BLVD
Mailing Address - Street 2:HOSPITALIST DEPT.
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3709
Mailing Address - Country:US
Mailing Address - Phone:251-639-5775
Mailing Address - Fax:251-631-3581
Practice Address - Street 1:6801 AIRPORT BLVD
Practice Address - Street 2:HOSPITALIST DEPT.
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3709
Practice Address - Country:US
Practice Address - Phone:251-639-5775
Practice Address - Fax:251-631-3581
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11036078363LA2100X, 363L00000X
AL1-098071363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care