Erin Tyler Clark
Individual provider Active NPI Athletic Trainer · Branford, FL
NPI 1255895694 · NPPES record last updated Jan 30, 2019
Key facts
- NPI
- 1255895694
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 2000008970 (FL)
- Practice address
- 405 Reynolds St NE
Branford, FL 32008-2861 - Phone
- (386) 935-5614
- NPI assigned
- Jan 30, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2000008970 | FL | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 2000008970 | FL | Yes |
Addresses
Primary practice location
405 Reynolds St NE
Branford, FL 32008-2861
Mailing address
4171 County Road 252
Wellborn, FL 32094-2620
Phone (386) 688-0925
Other providers in Branford, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 30, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.