Provider Demographics
NPI:1497292049
Name:CLARK, ROSHUNYA SHAVON (ARNP)
Entity Type:Individual
Prefix:
First Name:ROSHUNYA
Middle Name:SHAVON
Last Name:CLARK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 17TH ST STE G
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234-8666
Mailing Address - Country:US
Mailing Address - Phone:352-870-5025
Mailing Address - Fax:
Practice Address - Street 1:1750 17TH ST STE G
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-8666
Practice Address - Country:US
Practice Address - Phone:941-366-5333
Practice Address - Fax:941-331-2540
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9214368163WA0400X, 363LA2200X
FLAPRN9214368363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health