Provider Demographics
NPI:1104242205
Name:CLARK, AUSTINE LEIGH (CFNP)
Entity type:Individual
Prefix:
First Name:AUSTINE
Middle Name:LEIGH
Last Name:CLARK
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14440 CEDAR RD.
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121
Mailing Address - Country:US
Mailing Address - Phone:216-381-8726
Mailing Address - Fax:216-381-4426
Practice Address - Street 1:14440 CEDAR RD.
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44121
Practice Address - Country:US
Practice Address - Phone:216-381-8726
Practice Address - Fax:216-381-4426
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15685NP363LF0000X
OHCOA.15685-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily