Individual provider · Type 1 NPI
Timetra Diane Clark, FNP-BC
Family Nurse Practitioner · Chicago, IL
NPI number
1316687650
Active
Practice location
1401 E 55th St Apt 905N
Chicago, IL 60615-5468
Other practice locations
- 11026 Pony Gate, San Antonio, TX 78254-5999 · (847) 616-0269
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nephrology Registered Nurse | 163WN0300X | 041436444 (IL) |
| Nephrology Registered Nurse | 163WN0300X | 9562544 (FL) |
| Nurse Practitioner | 363L00000X | 209024791 (IL) |
| Family Nurse Practitioner Primary | 363LF0000X | 209024791 (IL) |
Family Nurse Practitioner: Definition to come...
Another provider at this address
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About NPI 1316687650
Timetra Diane Clark, FNP-BC's National Provider Identifier is 1316687650, issued on Apr 1, 2022. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Chicago, IL. The record was last updated on Apr 1, 2022.