Provider Demographics
NPI:1962960369
Name:KARLEE CLARK LLC
Entity type:Organization
Organization Name:KARLEE CLARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:850-898-8000
Mailing Address - Street 1:3866 BAY WIND DR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-2992
Mailing Address - Country:US
Mailing Address - Phone:850-748-0712
Mailing Address - Fax:
Practice Address - Street 1:3866 BAY WIND DR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-2992
Practice Address - Country:US
Practice Address - Phone:850-748-0712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-05
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty