1. Home
  2. Directory
  3. California
  4. Riverside
  5. Physician Assistant
  6. NPI Profile

TATIANNA CLARK
NPI 1104692144
Physician Assistant - Medical in Riverside, CA

Active since November 30, 2023
3940 POLK ST UNIT A, RIVERSIDE, CA 92505(818) 632-4265 Get Directions Write a Review

NPPES record last updated: November 30, 2023. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Tatianna Clark NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TATIANNA CLARK (NPI 1104692144) is an individual medical provider in Riverside, California, licensed in California (63689) and active in the NPI registry since November 2023.

NPPES Registry Identity

NPI1104692144
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameTATIANNA CLARK
Location Address3940 POLK ST UNIT ARiverside, CA 92505-1998
Mailing Address3940 Polk St Unit ARiverside, CA 92505-1998
Phone(818) 632-4265
Sole ProprietorYes
Enumeration DateNovember 30, 2023
NPPES CertifiedNovember 30, 2023
✔ NPI 1104692144 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in CA · 63689
3940 POLK ST UNIT A, Riverside, CA 92505
Open in Google Maps ↗

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tatianna Clark's NPI number?

The NPI number for Tatianna Clark is 1104692144. It was assigned to this individual provider in the NPPES registry on November 30, 2023.

Where is Tatianna Clark located?

Tatianna Clark practices at 3940 Polk St Unit A, Riverside, CA 92505. The listed phone number is (818) 632-4265.

What is Tatianna Clark's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

When was this NPI record last updated?

The NPPES record for Tatianna Clark was last updated on November 30, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.