Provider Demographics
NPI:1265184899
Name:CLARK, VICTORIA ALEXANDRIA (APRN)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:ALEXANDRIA
Last Name:CLARK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:VICTORIA
Other - Middle Name:ALEXANDRIA
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 748817
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8817
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:4321 N MACDILL AVE STE 205
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6390
Practice Address - Country:US
Practice Address - Phone:813-961-7440
Practice Address - Fax:813-962-0951
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11017713363LF0000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health