Clark, Stacey Ann
Clark, Stacey Ann is an individual health care provider with primary practice located at 1447 Medical Park Blvd #402, Wellington FL 33414. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Clark, Stacey Ann can be contacted via phone (561) 790-2600.Contact Information
Primary practice address
1447 Medical Park Blvd #402
Wellington FL 33414
Phone: (561) 790-2600
Fax: (561) 790-1535
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | ME0070966 | Florida |
Profile Details
| NPI number | 1285606574 |
|---|---|
| LBN Legal business name | Clark, Stacey Ann |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 2nd, 2006 |
| Last updated | Mar 29th, 2011 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1285606574 | NPPES |
| Florida | MEDICAID | 47177100 |
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