| Doctor Name: | AUSTINE LEIGH CLARK |
| NPI Number: | 1104242205 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CFNP |
| License Number: | COA.15685-NP |
| Business Practice Address: | 2054 S Green Rd South Euclid, OH - 441214243 |
| Business Phone Number: | 2162919210 |
| Business Fax Number: | 2162919422 |
| Mailing Address: | 2054 S Green Rd, SOUTH EUCLID |
| State: | OH |
| Postal Code: | 441214243 |
| Phone Number: | 2162919210 |
| Fax Number: | 2162919422 |
| NPI Enumeration Date: | 03/13/2014 |
| NPI Last Update Date: | 03/13/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | COA.15685-NP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |