Provider Demographics
NPI:1861382509
Name:CLARK, NATASHA (RN)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1060 LINCOLN AVE STE 20
Mailing Address - Street 2:SUITE 20 #1188
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1060 LINCOLN AVE STE 20
Practice Address - Street 2:SUITE 20 #1188
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3110
Practice Address - Country:US
Practice Address - Phone:408-800-6189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-04
Last Update Date:2025-07-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95173843163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics