Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jaquell Clark

Individual provider Registered Nurse · NPI 1407732001

Jaquell Clark is a Registered Nurse in Medford, New York. Practices as a sole proprietor. Licensed in New York.

Licensed in
NY
In the registry since
2025

Practice location Address checks out

97 Maple Ln
Medford, NY 11763-1028
Phone: (631) 882-7216
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Registered Nurse (primary) Taxonomy 163W00000X · Licence 849553 (NY)

Record details

NPI number1407732001
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedAugust 12, 2025
Last updated in NPPESAugust 12, 2025
Certification dateAugust 12, 2025
Mailing address97 Maple Ln, Medford, NY 11763-1028

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