Provider Demographics
NPI:1629855036
Name:CLARK, RACHEL LEAH (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LEAH
Last Name:CLARK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LEAH
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:369 DEER RUN RD
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-1125
Mailing Address - Country:US
Mailing Address - Phone:864-516-7033
Mailing Address - Fax:
Practice Address - Street 1:369 DEER RUN RD
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-1125
Practice Address - Country:US
Practice Address - Phone:386-451-6703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9235916163W00000X
FLF07230175363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse