Provider Demographics
NPI:1154914257
Name:CLARK, SANA (RN)
Entity type:Individual
Prefix:MRS
First Name:SANA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6801 LAKE WORTH RD
Mailing Address - Street 2:SUITE 213 - 214
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467
Mailing Address - Country:US
Mailing Address - Phone:561-444-2351
Mailing Address - Fax:561-865-7841
Practice Address - Street 1:6801 LAKE WORTH RD
Practice Address - Street 2:SUITE 213 - 214
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467
Practice Address - Country:US
Practice Address - Phone:561-444-2351
Practice Address - Fax:561-865-7841
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9483520163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse