Provider Demographics
NPI:1871320051
Name:CLARKE, TALICIA (NURSE AIDE)
Entity type:Individual
Prefix:
First Name:TALICIA
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:NURSE AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 DEAN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-2987
Mailing Address - Country:US
Mailing Address - Phone:860-420-6857
Mailing Address - Fax:
Practice Address - Street 1:105 DEAN LAKE RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-2987
Practice Address - Country:US
Practice Address - Phone:860-420-6857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10088646376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide