Provider Demographics
NPI:1225292386
Name:CLARK, SHARLA REBEKAH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SHARLA
Middle Name:REBEKAH
Last Name:CLARK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:305-500-2027
Mailing Address - Fax:305-500-2155
Practice Address - Street 1:1860 S SEGUIN AVE
Practice Address - Street 2:BLDG E.
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3914
Practice Address - Country:US
Practice Address - Phone:830-626-7770
Practice Address - Fax:855-278-4535
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03095363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA03095OtherPA LICENSE
TX320252502Medicaid
TX320252502Medicaid