Provider Demographics
NPI:1851808190
Name:CLARK, TONI LYNETTE (APRN)
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:LYNETTE
Last Name:CLARK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1020 LAKE SUMTER LNDG
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-2699
Mailing Address - Country:US
Mailing Address - Phone:352-674-8905
Mailing Address - Fax:352-674-8919
Practice Address - Street 1:2400 N ESSEX AVE
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442-5320
Practice Address - Country:US
Practice Address - Phone:352-513-4276
Practice Address - Fax:352-513-5843
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN9297900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner