Provider Demographics
NPI:1417679176
Name:CLARK, SHINIKA (NP, PMHNP)
Entity Type:Individual
Prefix:
First Name:SHINIKA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:NP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 CLYDE MORRIS BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:285 CLYDE MORRIS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8144
Practice Address - Country:US
Practice Address - Phone:386-672-7113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11022123363LP0808X
FLRN9392948163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation