| Doctor Name: | JENNIFER ANNE CLARKE |
| NPI Number: | 1700274255 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | F338452-1 |
| Business Practice Address: | 2127 Dryden Rd Freeville, NY - 130689611 |
| Business Phone Number: | 6078449979 |
| Business Fax Number: | 6078449066 |
| Mailing Address: | Po Box 640, DRYDEN |
| State: | NY |
| Postal Code: | 130530640 |
| Phone Number: | 6078449979 |
| Fax Number: | 6078449066 |
| NPI Enumeration Date: | 01/07/2015 |
| NPI Last Update Date: | 01/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | F338452-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |