Provider Demographics
NPI:1285081299
Name:CLARK, TARA MARIA (FNP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:MARIA
Last Name:CLARK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33463 GLOBE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93265-9719
Mailing Address - Country:US
Mailing Address - Phone:559-539-5788
Mailing Address - Fax:
Practice Address - Street 1:380 N RESERVATION RD
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-9673
Practice Address - Country:US
Practice Address - Phone:559-784-2316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44838363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily