| Doctor Name: | JAN ELLEN CLARK |
| NPI Number: | 1992950794 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | AS4375 |
| Business Practice Address: | 3441 E Colonial Dr Ste F-32 Orlando, FL - 328035113 |
| Business Phone Number: | 4072065703 |
| Business Fax Number: | 4072065704 |
| Mailing Address: | 8001 S Orange Blossom Trl, Fl Mall Suite 692 ORLANDO |
| State: | FL |
| Postal Code: | 328097654 |
| Phone Number: | 4078597005 |
| Fax Number: | 4078502635 |
| NPI Enumeration Date: | 11/20/2008 |
| NPI Last Update Date: | 10/06/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 237700000X |
| License Number: | AS4375 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Hearing Instrument Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Individuals who test hearing for the selection, adaptation, fitting, adjusting, servicing, and sale of hearing aids. Hearing Instrument Specialist is a designation provided individuals who qualify by the National Hearing Aid Society |