Provider Demographics
NPI:1609899871
Name:CLARK, ANNE (ARNP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:38135 MARKET SQUARE
Mailing Address - Street 2:
Mailing Address - City:ZEPHRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542
Mailing Address - Country:US
Mailing Address - Phone:813-780-1255
Mailing Address - Fax:813-780-9773
Practice Address - Street 1:2100 VIA BELLA BLVD
Practice Address - Street 2:STE. 204
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-5429
Practice Address - Country:US
Practice Address - Phone:813-751-3636
Practice Address - Fax:813-377-1678
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP1600042363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300899100Medicaid
FL500014246OtherRR MEDICARE
FLY6682XMedicare PIN
S64141Medicare UPIN